Gene W. Matthews, J.D. CDC Foundation 50 Hurt Plaza, Suite 765 Atlanta, GA 30303 (404) 373-1276 MatthewsPHLaw@aol.com

1. Institute of Public Health Law Gene W. Matthews, J.D. CDC Foundation 50 Hurt Plaza, Suite 765 Atlanta, GA 30303 (404) 373-1276 MatthewsPHLaw@aol.com INSTITUTEofPUBLICHEALTHLAW

2. Historical Role of Attorneys and 21st Century Public Health Practice ABA Center for Continuing Legal Education Understanding the Role of Public Health in Your Practice August 10, 2005 INSTITUTEofPUBLICHEALTHLAW

3. Historical Context • 100 years ago, lawyers were integral to the practice of public health at the community level • Example, Teddy Roosevelt and Long Island polio quarantine of 1890’s • Example, in 1905 a Chicago lawyer founded the Rotary Club: --Purchased a horse for the doctor --Built the first public restroom in Chicago INSTITUTEofPUBLICHEALTHLAW

4. HISTORICAL CONTEXT 1950’s : Two Ships Passed in the Night! Salk Polio Vaccine – 1955 (END IN U.S. OF COMMUNITY-WIDE PUBLIC HEALTH CONTROL MEASURES—300 years!) Brown v. Board of Education 1954 (BEGINNING OF MODERN EVOLUTION OF PROCEDURAL PROTECTIONS OF INDIVIDUAL LIBERTIES AGAINST GOVERNMENT ACTION) INSTITUTEofPUBLICHEALTHLAW

5. “A renaissance is now taking place in public health law”(…and just in time!) INSTITUTEofPUBLICHEALTHLAW

6. Natural Events 21st Century Emerging Infections Mad Cow Disease West Nile Virus SARS Monkey Pox Avian Flu Marburg Disease?? Cascade of Communications Challenges INSTITUEofPUBLICHEALTHLAW

7. 21st Century: Travel Time vs. Population Density Population Density Travel Time INSTITUEofPUBLICHEALTHLAW

8. Human Events 21st Century Asymmetrical Terrorism Bioterrorism Events Anthrax attacks of 2001 Smallpox vaccinations of 2003 Ricin events in 2003-2004 “Conventional” Weapon Events Airliner hijackings of 9/11/2001 Madrid subway attacks of 2004 London transit attacks of 2005 Chemical & Nuclear Threats Chemical weapon concerns-(Sarin gas in Tokyo subway) “Suitcase bomb” & “dirty bomb” scenarios Communications Cascade INSTITUEofPUBLICHEALTHLAW

9. Question: “Why should I care?” Answer: “In an outbreak situation, the private sector cannotafford for government to fail!” • Governments are facing multi-level budget deficits-federal, state, & local • In an outbreak, government is going to need the help of the private sector INSTITUTEofPUBLICHEALTHLAW

10. Law/Policy Change in Public Health Emergency “Emergency” THE RED ZONE (Culture temporarily Changes) Immediate Aftermath Moment of Law & Policy Change THE GREEN ZONE “normal time” …and… “THE BLAME GAME” may begin! (Selective Amnesia Returns) INSTITUTEofPUBLICHEALTHLAW

11. The Toronto Example of the RED ZONE—2003 SARS 30,000 “voluntary” quarantines over 3 months 27 formal quarantine orders…and.. 1 appeal (withdrawn)MORE SOCIAL COHESIONToronto experienced a temporary shift increasing social cohesionCompliance with quarantine directives was substantial One example of how a culture temporarily changes NOT DIVISIVENESS & PANIC INSTITUTEofPUBLICHEALTHLAW

12. A “Tipping Point” for SARS Leadership in Toronto On the day that the large medical convention cancelled in Toronto, the center of leadership shifted: A Health Problem for An Economic Problem Government Leaders for Business Leaders To Solve To Solve BECAME INSTITUTEofPUBLICHEALTHLAW

13. Initial Lessons • Lessons from Toronto are readily understandable and are transferable to other settings. • The Biggest Lesson: The “Balance of Governance” is significantly (if only temporarily) altered during an emergency. • Business and Public Health need to build bridges with each other before a crisis. INSTITUTEofPUBLICHEALTHLAW

14. The Green Zone: Normal Times Normally, there is distance between these entities because of different goals, agendas, & strategies INSTITUTEofPUBLICHEALTHLAW

15. The RED ZONE: An Emergency Businesses engage & lead in economic recovery plans Persons are more likely to follow quarantine orders Employees get their information through their employers Relationships are altered during an emergency—we need to plan for it…now. INSTITUTEofPUBLICHEALTHLAW

16. An Example of One Window of Change:Rapid National Legal/Policy Changes That Followed 9/11/01 • Department of Homeland Security created • BT Infrastructure Block Grants to states • USA PATRIOT Act Enacted • Select Agent Rule for control of BT pathogens • Model State Emergency Health Powers Act Drafted • Airline Recovery Legislation Enacted INSTITUTEofPUBLICHEALTHLAW

17. Law/Policy Change in Public Health Emergency “Emergency” THE RED ZONE (Culture temporarily Changes) Immediate Aftermath Moment of Law & Policy Change THE GREEN ZONE “normal time” …and… “THE BLAME GAME” may begin! (Selective Amnesia Returns) INSTITUTEofPUBLICHEALTHLAW

18. What can we do to plan for moments of legal and policy change? • Start linking businesses, governments, & civic leaders about this agenda • Use civic groups, trade associations, academic centers & preparedness forums to address these obvious issues. • Examinelegalconcerns: sick leave policies, liability limitation, compensation, insurance coverages, Good Samaritan Laws, etc. • Recognize that the “normal”, risk-averse decision-making does not always work in the Red Zone INSTITUTEofPUBLICHEALTHLAW

19. A Reminder for the 21st Century Rediscover leadership role of community lawyers in public health • Remember the model of 100 years ago • Lawyers are also interested in community public health issues beyond emergency preparedness • Policy reform is instinctive to lawyers INSTITUTEofPUBLICHEALTHLAW

20. Institute of Public Health Law Gene W. Matthews, J.D. CDC Foundation 50 Hurt Plaza, Suite 765 Atlanta, GA 30303 (404) 373-1276 MatthewsPHLaw@aol.com "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.” INSTITUTEofPUBLICHEALTHLAW