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Public Health Law

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Health officials did not realize that powder as fine as chalk dust might leak ... of the individualism and the cult of the entrepreneur that has predominated ... – PowerPoint PPT presentation

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Title: Public Health Law


1
Public Health Law
  • BIO-TERRORISM
  • Robert Kaman, JD, PhD

2
KILL ONE,
FRIGHTEN 10,000
-- Tom Clancy The Sum of All Fears
3
The Failure of the Public Health Response
  • Pearl Harbor all over again? Following 9-11 and
    the Afghanistan attacks, we were subjected to an
    anthrax attack.
  • Health officials did not realize that powder as
    fine as chalk dust might leak from an envelope
  • Postal workers were not tested and treated as
    quickly as congressional staffers
  • Public statements about the size and hazards of
    the spores were inconsistent and confusing
  • Still no guilty parties identified

4
Isolated case, or symptomatic of a failed system?
  • Fifty years of decreasing commitment to an
    effective public health system.
  • Liberals viewed public protection as an attack on
    civil liberty
  • Conservatives have opposed government funding of
    medical services, viewing it as a personal choice
  • Different reasons, but the same effect
  • An absence of political support for public health
    programs and institutions.

5
What do we have now?
  • Ill-funded system
  • Fragmented
  • Highly respectful of personal choice
  • Founded on antiquated laws which actually thwart
    decisive public health action
  • They often prohibit data-sharing between public
    health, law enforcement and emergency management
    agencies
  • They do not provide adequate powers for
    controlling property and persons in the event of
    bio-terrorism.
  • Unprepared for a nationally-coordinated response
    to crisis.

6
Example Public Health Response to AIDS
  • Minimal intrusion on personal autonomy and
    privacy
  • Government viewed as a threat rather than a
    solution
  • Civil-libertarian response to AIDS is reflective
    of the individualism and the cult of the
    entrepreneur that has predominated in American
    society for the past twenty years

7
The Threat
  • In an era of intercontinental travel, the US is
    vulnerable to epidemics of potentially massive
    proportion
  • Anthrax
  • Multi-drug resistant tuberculosis
  • AIDS
  • West Nile Virus
  • Smallpox
  • Ebola
  • SARS

8
Solution? New Federal and State Laws
  • Mobilization of needed resources and the
    permission - no the requirement to share
    information and to establish interagency (public
    health, law enforcement, emergency management)
    cooperation
  • Effective utilization of the medical technology
    we possess (antibiotics, vaccines, other
    biological security measures) to cope with the
    threats that we will face
  • Willingness to sacrifice certain virtues of
    personal autonomy against the larger backdrop of
    the common good.

9
Federal Programs
? Domestic Preparedness - Interagency effort
directed by Congress - AKA Nunn-Lugar
Domenici City Training ? Consequence Management
Program - Department of Defense efforts
directed by SECDEF - Improve Department
of Defense support for response to WMD
attacks - Integrate National Guard and
Reserve components
10
STATE PROGRAMSThe Model State Emergency Health
Powers Act (MSEHPA)
  • Principal Author Lawrence O. Gostin, JD
  • Professor and Director
  • Center for Law and the Publics Health
  • Georgetown University Law Center, Johns Hopkins
    University and the CDC
  • Washington, DC

11
MSEHPA
  • Five basic public health functions to be
    facilitated by the MSEHPA
  • Preparedness
  • Takes effect immediately
  • Surveillance
  • Takes effect immediately
  • Management of Property
  • Takes effect only after governor declares
    emergency
  • Protection of Persons
  • Takes effect only after governor declares
    emergency
  • Public Information and Communication

12
What is a Public Health Emergency?
  • The occurrence of imminent threat of an illness
    or health condition caused by bio-terrorism or a
    novel or previously controlled or eradicated
    infectious agent or biological toxin. The health
    threat must pose a high probability of a large
    number of deaths or serious disabilities in the
    population.

13
MSEHPA
  • Facilitates systematic planning for a public
    health emergency
  • Coordination of services
  • Procurement of vaccines and pharmaceuticals
  • Housing, feeding and caring for affected
    populations appropriate to physical, cultural
    and social needs
  • Proper vaccination and treatment of individuals
  • Authority for surveillance of health threats
  • Continuing power to follow a developing public
    health emergency.

14
MSEHPA
  • Requires prompt reporting by health care
    providers, pharmacists, veterinarians, and
    laboratories
  • Provides for exchange of relevant data among lead
    agencies such as public health, emergency
    management and public safety
  • Comprehensive power to manage property and to
    protect persons, and to safeguard the publics
    health and security

15
MSEHPA
  • Authority to close, decontaminate or procure
    facilities and materials to respond to a public
    health emergency
  • Safely dispose of infectious waste
  • Obtain and deploy health care supplies
  • Physically examine or test individuals as
    necessary for diagnosis or treatment
  • Vaccinate or quarantine individuals to prevent
    transmission of contagious disease
  • Waive licensing requirements to facilitate
    treatment

16
MSEHPA
  • Provides for a set of post-declaration powers and
    duties to ensure appropriate public information
    and communication.

17
MSEHPA
  • Creates a Public Health Emergency Planning
    Commission which
  • Must deliver a plan for responding to a public
    health emergency within six months of its
    formation.
  • Fifteen or more elements
  • declaration,
  • central coordination,
  • organization of resources,
  • compliance with reporting requirements,
  • engagement of the judicial system,
  • population evacuation,
  • housing and feeding plan,
  • organization of personnel,
  • vaccination,
  • treatment of persons exposed,
  • disposal of infectious waste and human remains,
  • isolation and quarantine plan,
  • tracking,
  • involvement of city and county government in the
    above,
  • cultural, ethnic and religious relevance plan,
  • other measures that may be deemed necessary.

18
MSEHPA
  • Declaration of a Public Health Emergency
  • Governor declares
  • Content
  • The nature of the emergency
  • The political subdivisions or geographic areas
    involved
  • The conditions that have caused the emergency
  • The duration of the emergency, if less than 30
    days
  • The primary public health authority responding

19
MSEHPA
  • Effect of the Declaration activation of the plan
  • Emergency powers
  • Coordination of resources
  • Personnel identification
  • Enforcement
  • Public health authority may request from public
    safety and militia

20
MSEHPA
  • Measures to Detect and Track Public Health
    Emergencies
  • Reporting
  • Illness or health condition
  • Pharmacists
  • Manner of reporting
  • Animal diseases
  • Laboratories
  • Enforcement

21
MSEHPA
  • Tracking
  • Identification of individuals
  • Interviewing individuals
  • Examination of facilities or materials
  • Enforcement
  • Information Sharing
  • Public safety authority must notify the public
    health authority, and vice versa upon evidence of
    a possible public health emergency
  • Information restricted to the minimum required

22
MSEHPA
  • Special Powers
  • Management of Property
  • Facilities
  • Materials
  • Access to and control of facilities and property
  • Use of materials and facilities
  • Use of health care facilities
  • Control of materials
  • Control of roads and public areas

23
MSEHPA
  • Safe Disposal of Infectious Waste
  • Adopt measures
  • Control facilities
  • Use of facilities
  • Identification of waste
  • Safe Disposal of Human Remains
  • Adopt measures
  • Possession
  • Disposal
  • Control and use of facilities
  • Labeling
  • Identification

24
MSEHPA
  • Control of Health Care Supplies
  • Procurement
  • Rationing
  • Priority
  • Distribution
  • Compensation
  • Destruction of property

25
MSEHPA
  • Special Powers Protection of Persons
  • Medical examination and testing
  • Vaccination and treatment
  • Isolation and quarantine
  • Authorization
  • Conditions and principles
  • Least restrictive
  • Isolated persons separated from quarantined
    persons
  • Health status monitored
  • Immediate release upon elimination of risk
  • Cooperation
  • Entry into isolation or quarantine premises
  • Authorized entry only
  • Extensive further considerations

26
MSEHPA
  • Collection of Samples for Testing
  • Marking
  • Contamination
  • Chain of custody
  • Criminal investigation
  • Access to and Disclosure of Protected Health
    Information

27
MSEHPA
  • Licensing and Appointment of Health Personnel
  • Health care providers must serve as a condition
    of state licensing
  • Health care providers from other jurisdictions
    licensing waived
  • Appointment of medical examiner or coroner

28
MSEHPA
  • Public Information Regarding Public Health
    Emergency
  • Dissemination of Information
  • Means of dissemination
  • Languages
  • Accessibility to persons with disabilities
  • Access to mental health support personnel

29
MSEHPA
  • Miscellaneous
  • Rules and regulations by public health authority
  • Financing and expenses
  • Transfer of funds
  • Repayment Conditions
  • Expenses authorized
  • Liability and immunity
  • Compensation

30
MSEHPA
  • Termination of Declaration
  • Executive Order
  • Automatic Termination
  • State Legislature
  • Content of termination order

31
MSEHPA
  • What will Texas do? Senate Bill 399 was
    introduced by Letitia van Puttin in the Spring of
    2003, based on the MSEHPA.
  • An act relating to the powers of the governor
    and certain state agencies relating to public
    health, including public health emergencies.
  • The legislature failed to vote on the final bill,
    and it was not added to the special session
    agenda.
  • Texas did pass a homeland security bill, which
    contains some elements of the MSEHPA

32
Local Actions
  • Tarrant County Public Health Department created
    three 3-member Health Response Teams (HRTs) to
    respond to bio-terrorism
  • Investigation, assessment and coordination of
    response to suspected bio-terrorism
  • Coordinate response with law enforcement and
    hazmat officials
  • Receive and deliver bio-terrorism training on
    medical recognition of signs and symptoms of
    biological agents

33
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34
RECOMMENDATIONS
  • Be aware
  • Do not over-react
  • Listen to authorities
  • Take common sense precautions
  • - radio and batteries
  • - 3 - 5 day supply of food and water
  • - full tank of gas
  • - location of shelters
  • Participate in planning
  • Continue usual behavior
  • Follow the upcoming legislature look for the
  • reintroduction of a bill similar to SB 399
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