# Presentation: 753326

## PUBLIC HEALTH LAW June 30, 2003

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

*“**The findings and conclusions in this presentation have not *
*been formally disseminated by the Centers for Disease Control and Prevention and *
*should not be construed to represent any agency determination or policy.”*

**PUBLIC HEALTH LAW**
- I.  	HISTORICAL CONTEXT
- II.	CURRENT SITUATION
- III.	FUTURE EXPECTATIONS

## I.  HISTORICAL CONTEXT

**PUBLIC HEALTH = **_**POLICE**_** POWER **
**	**
**10****TH**** AMENDMENT = **_**STATE**_** RESERVED!**
_**Federal**_** Functions**
**International**
**Interstate**
**Federal Funding & Assistance**

## I.  HISTORICAL CONTEXT (cont.)

- Turn of the 20th Century: _One Sentence_ 	Emergency Health Power Laws
- Post WWII: Golden Era Began
- Vaccines
- Antibiotics

## I.  HISTORICAL CONTEXT (cont.)

**Early 1900’s - Role of Lawyers as part ****	****of Public Health Leadership**
**Mid 1900’s**
**	****Public Health Clinical “Silos”**
**	****Health Officers ******** Political Arena**
**	****PH Lawyers ******** “Technicians”**

_**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)**

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

|  | 
PUBLIC HEALTH | LAW
ENFORCE
    MENT | EMER.
MGMT. | MED.
CARE
SERVICE | AGRI/
 VET-
   MED |
| --- | --- | --- | --- | --- | --- |
| FEDERAL | P.H. | L.E. | EMA | MED   CARE | USDA |
| STATE
 | P.H. | L.E. | EMA | MED    CARE | STATE
  AGRI |
| LOCAL
 | P.H. | L.E. | EMA | MED   CARE | LOCAL  DVM’s |

## II.  CURRENT SITUATION

- 	**-BUDGET CRUNCH IN GOVERNMENTS**
**	****-”SILOS”**
**	****-ARRIVAL OF ****”FIVE SHADOWS”**** **
** ****Ax + W. Nile + Sx + SARS + Mx**

## II. CURRENT SITUATION	INFORMATION

_***-Public Health Law: Power, Duty, Restraint***_**, Lawrence O. Gostin,  U. of Calif. Press, 2000**
_***-Law in Public Health Practice***_**, Oxford Press, 2003**
**-CDC Web Postings on Smallpox Legislation and SARS Federal Quarantine Legal Aspects + Mx Animal Embargos**
**-****Smallpox Legal Clearinghouse – Fred Shaw**

## Slide 10

##    II. CURRENT SITUATION	         TRAINING “FORENSIC EPIDEMIOLOGY” COURSE

_**“**__**HOW DO P.H. & L.E. INVESTIGATIONS CONNECT WITH EACH OTHER??**_
- -Compare Different Investigational Approaches
- -“Who is in charge? ...and When?”
- -Chain of custody
- -Information sharing / confidentiality issues
- -Historical Teaching Examples

## II. CURRENT SITUATION	         TRAINING “FORENSIC EPIDEMIOLOGY” COURSE

**-Enormous interest.**
**-Joint DOJ Participation**
**-Saturating Down to State and Local L.E. + P.H.**
**-Expand Horizontally to EMA, Nat. G., Agri, etc.**
**-Several “Funding Streams” Available**

## CURRENT SITUATION Partnerships

- Federal International /Interstate
-      Authority and Jurisdiction—Mx Embargo
**Federal Funding to States**
-     -$1 Billion in HHS State Grants x 2 yrs
-      -Includes funding for state review of
- 		their laws, regs, procedures, etc.

## II. CURRENT SITUATION	Partnerships

_**CDC’s 2nd Annual Partnership Conference**_
**	**_**Public Health & the Law in 21**__**st**__** Century**_** **
**	****	****	**_**June 16-18, 2003**_
**	****Health Officers**
**	****Legislators**
**	****Public Health Attorneys**
**	****Academicians**
**	****Non Profit Organizations**

## III. FUTURE EXPECTATIONS 

**“****A RENAISSANCE IS NOW TAKING PLACE IN PUBLIC HEALH LAW”**

## III. FUTURE EXPECTATIONS

**Public View: Post 9/11**
**“****If there is an emergency, my ****government**_***s***_** ****need to have their acts together.”**
**- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -**
**Federal + State + Local Governments**
**PH+ Law Enf.+ EMA’s + Nat.Guard + Agri., etc.**
_**“**__**NO MORE SILOS”**_

## III. FUTURE EXPECTATIONS “CONNECT THE DOTS”

**Health**
**Officers**
**Academicians                           Legislators**
**              ****Non-Profits                 Attorneys**

## III. FUTURE EXPECTATIONS “ADDING NEW DOTS!!!!”

**Health**
**          **_** **__**AGRI**_**.          **** Officers    **_**LAW ENFORCE**_**.****   **
**Academicians                           Legislators**
**	****	**_**EMA’s**_**	****	****	****       **_**JUDICIAL**_
**              ****Non-Profits       ****?**** ****        Attorneys**

## III. FUTURE EXPECTATIONSCOMMUNITY BASED LEGALPREPAREDNESS DISCUSSIONS

**HOT BUTTONS!**
**-Indemnification**
**-Civil liberties and Discrimination**
**-Closure of Facilities**
**-Quarantine and Isolation**
**-Privacy/Disease Surveillance**
**-Smallpox Vaccine Policy & Drug Rationing**

## III. FUTURE EXPECTATIONS COMMUNITY-BASED LEGAL PREPAREDNESS DISCUSSIONS 

**Reach out through State and City Lawyers’ Associations + P.H. Officers**
**	**	**“****Has your bar association set up a “legal  **
**                  ****preparedness” working group...**_**yet**_**?**
**Natural Participants:**** Hospital Attorneys, Civil Liberties, Law Schools, Drug Cos., Professional Associations, Attny Gens., etc.**

## III. FUTURE EXPECTATIONS

_**The Role of Lawyers In Public Health**_
- --Historical => Community Leaders
- --Recent => Not Part of  P.H. Leadership
- 				OR
- 			=> “Technicians”
- --Future==> P.H. Is Now Reaching
- 				Outside the “Silo”

## Quarantine/Isolation

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

**Public good**

**Individual liberties**

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

## 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.**

## 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**