Quarantine and Isolation Law in the States

1. Quarantine and Isolation Lawin the States Frederic E. Shaw, MD, JD Public Health Law Program, PHPPO Centers for Disease Control and Prevention Atlanta, Georgia "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.”

2. The Police Power • Natural inherent authority of the sovereign to regulate private interests for the public good • Retained by the States, not ceded to the federal government • Includes wide powers to: • Restrict a person’s personal liberty • Restrict a person’s ability to work • Seize property

3. Concurrent State-Federal Q/I Authorities • Federal Q/I authority derives from Commerce Clause: • Congress shall have the power … “To regulate Commerce with foreign Nations, and among the several States… .” Art I, Section 8. • SARS: Federal quarantine authority could be applied to a single SARS case inside a state or local jurisdiction, if necessary. 42 USC §264 and 42 CFR §70.2 • State Q/I authority derives from retained “police power:” • State statutes and regulations

4. Are the States Legally Prepared? • Prepared for what? Epidemics (SARS)? BT? • What is “legally prepared”? • The Model State Emergency Health Powers Act • CDC SARS Plan • SARS Legal Preparedness Checklist (CDC) • Test by exercises

5. Components of Legal Preparedness • Legal authorities • Legal procedures • Fairness, due process • Defendability • Legal expertise and experience • Coordination among jurisdictions • Communications and education • Public health officials • Law enforcement • Judiciary

6. States’ Q/I Authority • Highly varied

7. Virginia Code § 32.1-43. Authority of Commissioner to require quarantine, etc. The Commissioner shall have authority to require quarantine, vaccination or treatment of any individual when he determines any such measure to be necessary to control the spread of any disease of public health importance.

8. Utah Code • 26-6b-3.Temporary involuntary treatment, isolation, and quarantine.       (1)  The department, or the local health department having jurisdiction over the location where an individual who is subject to supervision is found, may issue an order for the individual's temporary involuntary treatment, quarantine, or isolation pursuant to Subsection 26-1-30(2), 26A-1-114(1)(b), or Section 26-6-4 upon compliance with the requirements of this section.       (2)  An individual who is subject to supervision who willfully fails to voluntarily submit to treatment, quarantine, or isolation as requested by the department or the local health department may be ordered to submit to treatment, quarantine, or isolation upon:       (a)  written affidavit of the department or the local health department stating:       (i)  a belief that the individual who is subject to supervision is likely to fail to submit to treatment, quarantine, or isolation if not immediately restrained;       (ii)  this failure would pose a threat to the public health; and       (iii)  the personal knowledge of the individual's condition or the circumstances that lead to that belief; and       (b)  a written statement by a licensed physician indicating the physician finds the individual is subject to supervision.       (3)  A temporary order issued under Subsection (1) may:       (a)  be made by the department or by the local health department;       (b)  order the individual to submit to reasonable involuntary treatment, quarantine, and isolation, or any of these; and       (c)  not require an individual to be subject to involuntarily quarantine, isolation, or treatment for more than five days, excluding Saturdays, Sundays, and legal holidays, unless a petition has been filed with the district court pursuant to Section 26-6b-5.       (4) (a)  Pending issuance of an examination order pursuant to Section 26-6b-5 or an order for involuntary quarantine, isolation, or treatment from a district court pursuant to Section 26-6b-6, the individual who is the subject of the temporary order may be required to submit to involuntary quarantine, isolation, or treatment in his home, a hospital, or any other suitable facility under reasonable conditions prescribed by the department or the local health department.       (b)  The department or the local health department, whichever initially ordered the quarantine, isolation, or treatment, shall take reasonable measures, including the provision of medical care, as may be necessary to assure proper care related to the reason for the involuntary treatment, isolation, or quarantine of an individual ordered to submit to involuntary treatment, isolation, or quarantine.       (5)  The individual who is subject to supervision shall be served a copy of the temporary order, together with the affidavit and the physician's written statement, upon being taken into custody.  A copy shall also be maintained at the place of quarantine, isolation, or treatment.

9. States’ Q/I Authority • Highly varied • Depends upon the public health structure of the state • Usually, there is specific quarantine authority in a traditional public health statute • May be additional quarantine power in emergency powers statutes

10. States’ Legal Preparedness for SARS • Issues of concern: • Procedural requirements may make response to big outbreaks difficult. • Enforcement unclear in law • Ability to do group quarantine or area quarantine, without naming actual persons • Financial support for persons quarantined • Capacity of local health departments to carry out quarantine

11. Public Health Legal Surveillance • Idea: CDC should know about (monitor) the state of public health law in the states, akin to knowing about state of disease • Methods: • Read and analyze current and new statutes, rules, AG opinions and cases • Get descriptions from state p.h. lawyers • Post information for public use

12. http://www.phppo.cdc.gov/od/phlp/