# Presentation: 916947

## PUBLIC HEALTH COMMUNITY PREPAREDNESS for SARSMay 20,2003

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

## Quarantine

**Quarantine**

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

**Public good**

**Individual liberties**

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

**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 ******** **_**STATE**_** RESERVED!**
_**Federal**_** Functions**
- International
- Interstate
- Federal Funding & Assistance

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

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

## 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**

## 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.**

## 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).
- By law, U.S. Customs and Coast Guard assist in the enforcement of federal quarantine regulations.
- 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 compulsory public health order.**

## DUE PROCESS for QUARANTINE AND ISOLATION 

- _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 A _FLEXIBLE_ CONCEPT
_**REMEMBER THE BALANCING TEST!**_

## DUE PROCESS for MANDATORY QUARANTINE AND ISOLATION

- 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 government
- 	--_Access to Legal Counsel_
- 	--A _Final Decision_ that a Court Can Review.

## Legal Preparedness Vision

-             Health                              Public Health
- 		   Officers				Lawyers
- Law Enforcement

## 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**_
**Public Health Law Conference****: June 16-18, 2003 **_[http://www.phppo.cdc.gov/od/phlp/conference03/](http://www.phppo.cdc.gov/od/phlp/conference03/)_
**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**