1 / 32

\ Public Health Emergency Law

Public Health Emergency Law. Florida Department of Health. Presented by: Timothy M. Cerio, General Counsel Florida Department of Health Tallahassee FL t_cerio@doh.state.fl.us. Government Authority to Act in Emergencies: Model.

gtracy
Download Presentation

\ Public Health Emergency Law

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. \Public Health Emergency Law 1

  2. Florida Department of Health Presented by: Timothy M. Cerio, General Counsel Florida Department of Health Tallahassee FL t_cerio@doh.state.fl.us 2

  3. Government Authority to Act in Emergencies: Model • Legal authority is at its peak at the height of an emergency • As crisis comes under control, legal authority is subject to greater legal constraints • Attention then shifts to responsibility for costs and damages/losses 3

  4. Florida Public Health Agencies Public health authority varies by state & locality: • Florida’s agencies • DOH and CHDs • AHCA • DACS • Elder Affairs • DCF • Fish & Wildlife • Juvenile Justice 4

  5. DOH Authority for Disease Surveillance   The department may obtain and inspect copies of medical records, records of laboratory tests, and other medical-related information for reported cases of diseases of public health significance. Sec. 381.0031(5), FS 5

  6. HIPAA Public Health Deference HIPAA defers to the Public Health Authority State Law: Information submitted in reports [of diseases of public health significance] is confidential, . . . and is to be made public only when necessary to public health. A report so submitted is not a violation of the confidential relationship between practitioner and patient. Sec. 381.0031(4), FS 6

  7. HIPAA Public Health Deference 45 CFR 164.512(a)(1) A covered entity may use or disclose protected health information to the extent that such use or disclosure is required by law [including state law] Sec. 381.0031(1) FS:   Any practitioner licensed . . . to practice medicine, osteopathic medicine, chiropractic medicine, naturopathy, or veterinary medicine; any hospital . . .; or any laboratory . . . that diagnoses or suspects the existence of a disease of public health significance shall immediately report the fact to the Department of Health. 7

  8. Privacy:State Law Exemptions - Florida • When disclosures are permitted, must be: • ‘necessary to public health’ • Medial, police, other state agency officials, CDC • For particular purposes, such as: • Particular threat to public e.g. e-coli outbreak at petting zoos and state fair events • Limited to information required for those purposes 8

  9. Public Health Powers Available for Mandatory Isolation/Quarantine 9

  10. Quarantine and Isolation Federal law uses ‘isolation and quarantine.’ Florida Statutes nowhere mention ‘isolation’ – but only ‘quarantine.’ 10

  11. Federal Powers 11

  12. If State/Local Measures Inadequate 12

  13. State Power: Quarantine of Agricultural Goods • Quarantine of Goods • Florida DACS • Enforcement • By these same agencies, roadblocks • In conjunction with law enforcement, if necessary 13

  14. Florida Authority to Quarantine It is the duty of the Department of Health to: Declare, enforce, modify, and abolish quarantine of persons, animals, and premises as the circumstances indicate for controlling communicable diseases or providing protection from unsafe conditions that pose a threat to public health. Sec. 381.0011(6), FS 14

  15. FL Quarantine (proposed) • County Health Department order of quarantine (no pre-deprivation judicial role) • Covers people, animals, premises • States reason(s) why – facts known • Expiration date • Fast-track internal review of grounds • Habeas corpus review 15

  16. Principal Quarantine Actors • Public Health – reasons for quarantine • Law Enforcement – 2d degree misdemeanor • Judiciary – judges familiar issues associated with depriving people of liberty (criminal, TB statute, etc.) 16

  17. Role of Law Enforcement • Enforce health order on its face • Perimeter secured (cordon sanitaire) • Constructive custody (like TB detention) • Testify about non-compliance 17

  18. Role of Judiciary Physical Readiness: -- Measures to protect safety of hearing officers and participants Procedural Readiness: • Procedures for handling appearances • Court appointed counsel, bailiffs, court reporters Order release or more-coercive action, based on facts 18

  19. Alternatives to Mandatory Quarantine • Public Health Advisories (recommendations). Sec. 381.00315(1)(a), FS • Voluntary quarantine (in designated facility) • Masks and gloves • Self-quarantine at home 19

  20. Quarantine Enforcement • Police – in Florida, F.S. 381.0012(5) • National Guard - called up by Governor • National Guard - federalized by President • Military forces can be summoned • Enforcement of state quarantine is an exception to prohibition on use of military for domestic law enforcement (Posse Comitatus Act) 20

  21. Insufficient Enforcement 21

  22. Emergency Public Health Powers Available for Mandatory Vaccination & Treatment 22

  23. FL Authority to Require Vaccination or Treatment ‘Tests or treatment, including vaccination, for communicable disease . . . to comply with a quarantine .’ Sec. 381.0011(6)(a)3, FS. ‘Orders regarding quarantine shall . . . restrict or compel movement or actions . . . consistent with the protection of public health and accepted health practices. ‘For the purpose of orders regarding quarantine, the term “actions” encompasses isolation, closure of premises, testing, destruction, disinfection, treatment, and preventive treatment, including immunization.’ Rule 64D-3.007(1)-(2), FAC. 23

  24. History Lesson, Mandatory Vaccination Constitutionality of mandatory vaccination: • Jacobson v. Massachusetts, USSCt (1905) • 1902 smallpox outbreak in Cambridge, MA • Conviction for refusal to be vaccinated, $5 fine • Police power embraces “reasonable regulations” to protect public health and safety • “Upon principle of self defense, community has a right to protect itself against an epidemic disease” 24

  25. Federal Powers: Vaccination • No existing general federal authority for govt to mandate vaccination • Department of Defense and Department of State can require vaccination of servicemen after following specified procedures • Smallpox Emergency Personnel Protection Act of 2003 • Encourages vaccination by providing liability protection (for some of those vaccinating) and • Compensation for injuries caused by vaccination 25

  26. Issues of Importance During a Public Health Emergency 26

  27. Important Legal Issues:Mass Incidents Courts have not faced a true mass incident since flu pandemic in 1918-1919 Requirements for individual hearings will likely be relaxed when facing mass incident 27

  28. Important Legal Issues: Obligations to Those Under Quarantine: • Food – ESF-6 • Medical care – ESF-8 • Safety – ESF-16 • Sanitary needs – ? • How to extend these services without endangering delivery people? • How to extend services without degrading other services? • How to address special needs? 28

  29. Important Practical Issues:Encouraging Voluntary Compliance • Factors that undercut compliance: • Lost wages or income • Groceries and essential services • Boredom 29

  30. Pivotal Issue:Lessons from Canada: SARS SARS caused cancellation of major Toronto conventions, e.g. American Psychiatric Association, in domino fashion. The center of leadership in Toronto shifted. The fundamental context of SARS changed from being seen mainly as a health problem for government officials to solve; instead SARS was thereafter viewed also as an economic problem for the business leadership to solve. -- Gene Matthews, CDC Foundation 30

  31. Lessons from Canada: SARS Quarantine Enforcement Canadian experience with SARS • Over 30,000 quarantined in Toronto by provincial health authorities • Mandatory requirement that those exposed stay home • Only 27 formal quarantine orders were served • Only ONE formal appeal • Later voluntarily withdrawn after explanation 31

  32. Key Takeaways - Summary 1. Know the Legislation 2. Become Familiar with Agency Orders 3. Anticipate Practical Problems 4. Communication is Critical 32

More Related