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PUBLIC HEALTH EMERGENCY LEGAL PREPAREDNESS

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Title: PUBLIC HEALTH EMERGENCY LEGAL PREPAREDNESS


1
PUBLIC HEALTH EMERGENCY LEGAL PREPAREDNESS
  • Gene W. Matthews, J.D.
  • Public Health Law
  • 1126 Oxford Road, Atlanta,GA 30306
  • (404) 373-1276
  • MatthewsPHLaw_at_aol.com

2
  • PUBLIC HEALTH LAW
  • I. HISTORICAL CONTEXT
  • II. CURRENT SITUATION
  • III. FUTURE EXPECTATIONS

3
  • HISTORICAL CONTEXT
  • 1954 Two Ships Passed in the Night!
  • Salk Polio Vaccine 1954
  • (END IN U.S. OF COMMUNITY-WIDE PUBLIC
  • HEALTH CONTROL MEASURES300 years!)
  • Brown v. Board of Education 1954
  • (BEGINNING OF MODERN EVOLUTION OF PROCEDURAL
    PROTECTIONS OF INDIVIDUAL LIBERTIES AGAINST
    GOVERNMENT ACTION)

4
Quarantine
A collective action for the common good
Public good
Individual liberties
Paramount to meet needs of individuals infected
and exposed
5
HISTORICAL CONTEXT
  • PUBLIC HEALTH ? POLICE POWER
  • 10TH AMENDMENT ? RESERVED TO STATES
  • Federal Functions
  • International
  • Interstate
  • Federal Funding Assistance

6
Federal, State, and Local Legal Preparedness
The Silos
Public Health
Law Enforcement
Emergency Management
Medical Services
Courts
7
CURRENT SITUATIONSTATE AND LOCAL LAWS
  • Intrastate control measures come under
  • state laws and regulations
  • State laws may vary
  • Sometimes local laws may be useful

8
CURRENT SITUATIONFEDERAL 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.

9
CURRENT SITUATIONFEDERAL 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

10
INTERPLAY OF FEDERAL AND STATE/LOCAL LAWS
  • State local have primary responsibility for
    Quarantine and Isolation.
  • Federal has authority to prevent interstate
    spread international importation of disease.
  • HHS may accept state local assistance in
    enforcement of federal Q regulations
  • HHS may assist state local officials in their
    control of communicable diseases.

11
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.

12
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.

13
(No Transcript)
14
CURRENT SITUATION INFORMATION
  • DRAFT MODEL STATE EMERGENCY HEALTH POWERS ACT
    (MSEHPA)
  • www.publichealthlaw.net
  • (Click on Legislative Specifications for quick
    overview)
  • www.ncsl.org/programs/health/modelact.pdf
  • (for the recent NCSL Check List)
  • Designed to assist states in their review of
  • their laws, regulations, procedures

15
2003 SARS Lessons
  • CANADIAN EXPERIENCE WITH SARS
  • --OVER 27,000 PERSONS QUARANTINED IN TORONTO
  • --27 FORMAL QUARANTINE
  • ORDERS NEEDED TO BE SERVED
  • --1 FORMAL APPEAL
  • (LATER WITHDRAWN AFTER EXPOSURE WAS
    EXPLAINED)

16
2003 SARS Lessons
  • PRACTICAL EXPERIENCE IN TORONTO
  • DEMYSTIFIED
    QUARANTINE
  • Experienced Social Cohesion in PH Emergency
  • RESPONSIBILITY
    DIVISIVENESS
  • COOPERATION
    PANIC
  • Lesson gt When Presented With Clear
    Communication Practical Guidance, Public
    Behavior Can Be Very Responsible in a Public
    Health Emergency

17
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
  • --GOVT ORDERED ISOLATION / QUARANTINE
  • --INVENTED CONCEPT OF WORK QUARANTINE
  • --ACTIVE USE OF LAW ENFORCEMENT OFFICERS
  • TO SERVE PROCESS AND MONITOR

18
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

19
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

20
SARS Legal Preparedness
  • PLAN FOR DUE PROCESS
  • 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.

21
(No Transcript)
22
CURRENT SITUATION
  • -BUDGET CRUNCH IN GOVERNMENTS
  • -SILOS
  • -ARRIVAL OF FIVE SHADOWS
  • Ax W. Nile Sx SARS Mx

23
(No Transcript)
24
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

25
II. CURRENT SITUATION TRAINING FORENSIC
EPIDEMIOLOGY COURSE
  • -Enormous interestU.S. Attnys VERY interested
  • -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
  • -At least 36 states currently implementing

26
Federal, State, and Local Legal Preparedness
The Silos
Public Health
Law Enforcement
Emergency Management
Medical Services
Courts
27
III. FUTURE EXPECTATIONS
  • A RENAISSANCE IS NOW TAKING PLACE IN PUBLIC
    HEALH LAW

28
III. FUTURE EXPECTATIONS
  • Public View Post 9/11
  • If there is an emergency, my governments need to
    have their acts together.
  • - - - - - - - - - - - - - - - - - - - - - - - - -
    - - - - - - - - - - - - - - - - - - - - - - - - -
    - - - - - - - - - - - - - - - - - - - - - - - - -
    - -
  • Federal State Local Governments
  • PH Law Enf. EMAs Nat.Guard Agri., etc.
  • NO MORE SILOS

29
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
    groupyet?
  • Natural Participants Hospital Attorneys, Civil
    Liberties, Law Schools, Drug Cos., Professional
    Associations, Attny Gens., etc.

30
III. FUTURE EXPECTATIONS CONNECT THE DOTS
  • Health
  • Officers
  • Academicians
    Legislators
  • Non-Profits
    Attorneys

31
III. FUTURE EXPECTATIONS ADDING NEW DOTS!!!!
  • Health
  • AGRI. Officers LAW
    ENFORCE.
  • Academicians
    Legislators
  • EMAs JUDICIAL
  • Non-Profits ?
    Attorneys

32
(No Transcript)
33
21st CENTURY REVOLUTION
  • Adapted from
  • Germs, Norms, and Power
  • Global Healths Political Revolution
  • By David P. Fidler, Indiana University School of
    Law

34
Westphalian Governance
  • (Horizontal Governance)
  • -Sovereignty
  • -Non-interference with internal affairs
  • -Bilateral agreements and treaty

State A
State B
State C
35
Post-Westphalian Governance
  • Vertical Communication
  • Global access to communications technology

State A
State B
State C
36
Post-Westphalian Governance
  • WHO
  • travel alerts
    surveillance Media
  • Global access to communications technology


State A
State B
State C
37
The Toronto Paradox 25,000 voluntary
quarantines 66 formal orders 1
appeal (withdrawn)DEVISIVENESS
SOCIAL
PANIC
COHESIONMedia Impact on
Q? Parallels to WTC events of 9/11? Was
the culture temporarily changed? SOCIAL
RESEARCH NEEDED ASAP!
38
  • CDC Public Health
  • Law Program Website
  • www.phppo.cdc.gov/od/phlp
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