# Presentation: 127668

## Comparison of Health Laws

**Audrey Kaiser Manka, J.D.****Minnesota Assistant Attorney General**

*"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.” *

## Health Laws Compared in this Talk

** ****Health Threat Procedures Act****	**** ****§§ 144.4171-.4186**
** ****Tuberculosis Health Threat Act****	**** §§ 144.4801-.4813**
** ****Isolation and Quarantine Statute****	**** §§ 144.419-.4195**

## Covered Individuals

|  | Noncompliant Carrier 
Minn. Stat. §§ 144.4171-.4186 | Noncompliant TB Carrier 
Minn. Stat. §§ 144.4801-.4813 | Emergency Powers 
Minn. Stat. §§ 144.419-.4195 |  |
| --- | --- | --- | --- | --- |
|  |  |  | Isolation | Quarantine |
| Covered Individuals | Individual | Individual | Individual or Group | Individual or Group |

**Covered Individuals**

## Disease or Condition

|  | Noncompliant Carrier 
Minn. Stat. §§ 144.4171-.4186 | Noncompliant TB Carrier 
Minn. Stat. §§ 144.4801-.4813 | Emergency Powers 
Minn. Stat. §§ 144.419-.4195 |  |
| --- | --- | --- | --- | --- |
|  |  |  | Isolation | Quarantine |
| Disease or Condition | 1.	Directly transmitted
	-	sexually 	transmitted
	- 	blood borne; or
	-	direct or 	intimate skin 	contact
2.	Indirectly transmitted 
	(any other transmission) | Tuberculosis(includes both infectious and non- infectious Tuberculosis) | Infected by new, novel, or previously controlled communicable disease or bioterrorism.   | Likely to have been exposed to new, novel, or previously controlled communicable disease or bioterrorism.   |
|  |  |  | Does not include directly transmitted diseases, i.e. STDs |  |

**Disease or Condition**

## Notice

|  | Noncompliant Carrier 
Minn. Stat. §§ 144.4171-.4186 | Noncompliant TB Carrier 
Minn. Stat. §§ 144.4801-.4813 | Emergency Powers 
Minn. Stat. §§ 144.419-.4195 |  |
| --- | --- | --- | --- | --- |
|  |  |  | Isolation | Quarantine |
| Notice | Health Directive,
personally served in same manner as summons and complaint | Health Order, personally served by peace officer or disease prevention officer | Individual orders, or, if impracticable, group posting in conspicuous place.  If posting is impractical, the Court must use the best means available.  Notice rather than service. |  |

**Notice**

## Designation 

|  | Noncompliant Carrier 
Minn. Stat. §§ 144.4171-.4186 | Noncompliant TB Carrier 
Minn. Stat. §§ 144.4801-.4813 | Emergency Powers 
Minn. Stat. §§ 144.419-.4195 |  |
| --- | --- | --- | --- | --- |
|  |  |  | Isolation | Quarantine |
| Designation  | Health threat to others
- Carrier demonstrates an inability or unwillingness to act in such a manner as to not place others at risk of exposure to infection that causes serious disease, serious disability, or death.  
   i.e. repeated behavior that has been demonstrated epidemiologically to transmit the disease.   | Endangerment to public health.
	-	Carrier may 			transmit the 			disease to others 		by certain 			conduct:  
		i.e. 		- 	fails or refuses to 			submit to 				examination
		- 	misses 20% of 			appointments for 			DOT or two 				consecutive 				appointments
		- 	fails or refuses to 			complete 				treatment
		- 	fails or refuses to 			keep treatment 			appointments.   | Infected and isolation is an effective control strategy.

 | Likely to have been exposed and quarantine is an effective control strategy.
 |

**Designation **

## Burden of Proof

|  | Noncompliant Carrier 
Minn. Stat. §§ 144.4171-.4186 | Noncompliant TB Carrier 
Minn. Stat. §§ 144.4801-.4813 | Emergency Powers 
Minn. Stat. §§ 144.419-.4195 |  |
| --- | --- | --- | --- | --- |
|  |  |  | Isolation | Quarantine |
| Burden of Proof | - 	Reasonable cause 	for issuance of 	apprehend and 	hold order or 	temporary 	emergency hold
-	Clear and 	convincing at court 	hearing | -	Probable cause to 	issue health order
- 	Preponderance of 	evidence at 	preliminary hearing
- 	Clear and 	convincing evidence 	at final hearing | 	Standard for temporary 	hold: delay in I/Q would                     	significantly jeopardize 	MDH’s ability to limit or 	prevent transmission
   Probable cause to believe 	I/Q is warranted at 	ex parte hearing
- 	Clear and convincing 	evidence at court hearing |  |

**Burden of Proof**

## Enforcement Action

|  | Noncompliant Carrier 
Minn. Stat. §§ 144.4171-.4186 | Noncompliant TB Carrier 
Minn. Stat. §§ 144.4801-.4813 | Emergency Powers 
Minn. Stat. §§ 144.419-.4195 |  |
| --- | --- | --- | --- | --- |
|  |  |  | Isolation | Quarantine |
| Enforce-ment Action | Health Directive
↓
Petition to Enforce 
or 
Temporary Emergency Hold to protect the public health (72 hours) 
- either apprehend 	and hold, if at 		large, or
- 	order health 		facility to hold | Health Order 
↓
Notice of Obligation to Isolate or Examine (72 hour hold which may be extended by ex parte order for up to 6 days) 
or 
Apprehend and Hold 
↓
Preliminary hearing
↓
Final hearing (periodic review every 90 days) | Temporary hold upon Commissioner’s Directive 
(lasts up to 48 hours; petition must be filed with the court within 24 hours, then the court must rule within 24 hours after receiving petition) or
Ex parte Court Order (lasts up to 21 days) 
↓
Unless Court hearing requested (to be held within 72 hours and may extend I/Q for 30 days) 
↓
Hearing on Conditions of Isolation or Quarantine 
↓
Released immediately when Commissioner determines no further need for isolation/ quarantine, or automatically upon expiration of court order   |  |

**Enforcement Action**

## Location of Hearing

|  | Noncompliant Carrier 
Minn. Stat. §§ 144.4171-.4186 | Noncompliant TB Carrier 
Minn. Stat. §§ 144.4801-.4813 | Emergency Powers 
Minn. Stat. §§ 144.419-.4195 |  |
| --- | --- | --- | --- | --- |
|  |  |  | Isolation | Quarantine |
| Location of Hearing | County where carrier resides
 | County where carrier resides; May be in a hearing room in treatment facility or court may designate another location  | County where person is located or in an adjoining county, or Ramsey County (statewide jurisdiction) |  |

**Location of Hearing**

## Right to and Duties of Counsel

|  | Noncompliant Carrier 
Minn. Stat. §§ 144.4171-.4186 | Noncompliant TB Carrier 
Minn. Stat. §§ 144.4801-.4813 | Emergency Powers 
Minn. Stat. §§ 144.419-.4195 |  |
| --- | --- | --- | --- | --- |
|  |  |  | Isolation | Quarantine |
| Right to and Duties of Counsel | Recognizes right to counsel, including, if indigent, the right to court designated counsel.  

Counsel shall: 
- consult with 		person prior to 		hearing
- be given adequate 	time to prepare 
- continue 		representation until 	released by court - be a vigorous 		advocate | Court appointed.

Commissioner to provide certified copies of relevant medical records

Duty to communicate:
- statement of disputed 	facts
- names and addresses 	of witnesses and 	summary of 	testimony | Recognizes right to counsel, including, if indigent, the right to court designated counsel.   |  |

**Right to and Duties of Counsel**

## Court Ordered Measures

|  | Noncompliant Carrier 
Minn. Stat. §§ 144.4171-.4186 | Noncompliant TB Carrier 
Minn. Stat. §§ 144.4801-.4813 | Emergency Powers 
Minn. Stat. §§ 144.419-.4195 |  |
| --- | --- | --- | --- | --- |
|  |  |  | Isolation | Quarantine |
| Court Ordered Measures | - Education
- Counseling
- Treatment
- Medical tests
- Monitoring
- Cease and desist
- Supervised living | - Isolate and detain 	for treatment
- Examination
- Remain in treatment 	facility to complete 	course of treatment
- Exclude carrier from 	work or school as 	necessary
- Provide necessary 	medical and 	epidemiological data
- Testing of others in 	carrier’s household, 	workplace or school
- Follow contagion 	precautions | - Isolation
- Quarantine |  |

**Court Ordered Measures**

## Appeal Rights

|  | Noncompliant Carrier 
Minn. Stat. §§ 144.4171-.4186 | Noncompliant TB Carrier 
Minn. Stat. §§ 144.4801-.4813 | Emergency Powers 
Minn. Stat. §§ 144.419-.4195 |  |
| --- | --- | --- | --- | --- |
|  |  |  | Isolation | Quarantine |
| Appeal Rights | Court of Appeals shall hear appeal within 30 days
 | Court of Appeals shall hear appeal within 60 days | As per Minn. R. of Civ. Appellate Procedure  |  |

**Appeal Rights**