Federal Authority for Isolation and Quarantine

1. Federal Authority for Isolation and Quarantine Mary Trippler, Assistant U.S. Attorney “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. Federal Authority for Isolation and Quarantine When does the federal government step in?

3. Federal Authority to Isolate and Quarantine • Power to isolate and quarantine to protect public health is a police power • 10th Amendment generally reserves such powers to the states • States are generally responsible for public health matters within their borders

4. Federal Authority to Isolate and Quarantine • EXCEPTIONS • International importation of disease • Interstate spread of disease • Certain Indian lands • Federal reservations (prisons, hospitals, etc.)

5. Federal Authority to Isolate and Quarantine • 42 U.S.C. § 264 (Public Health Service Act) • 42 C.F.R. Part 71 • 42 C.F.R. Part 70 • Executive Order 13295 • 25 U.S.C. § 198

6. Federal Authority to Isolate and Quarantine • Federal authority is concurrent with state’s and allows the government to apprehend, detain or conditionally release individuals to prevent transmission of disease from state to state or importation of disease from foreign countries

8. Federal Authority to Isolate and Quarantine • Federally quarantinable diseases are listed in Executive Order 13295 • Amended in April, 2003, to include SARS • Others include cholera, diphtheria, plague, tuberculosis, smallpox, yellow fever and hemorrhagic fever

10. Federal Authority to Isolate and Quarantine • The CDC indicates that it is the government’s goal to use its authority only if an individual poses a threat to public health and refuses to voluntarily cooperate with a request to isolate or quarantine.

11. Federal Authority to Isolate and Quarantine • The federal government last used involuntary quarantine in 1963 in connection with a smallpox case. • However, the CDC routinely uses the Public Health Service Act to monitor and temporarily detain individuals suspected of carrying or being exposed to disease.

12. Federal Authority to Isolate and Quarantine • Customs and Border Protection and Coast Guard aid in enforcement of isolation and quarantine statutes and regulations • Violation of the Public Health Service Act, 42 U.S.C. § 264, has a maximum penalty of • $1,000 fine • One year in prison

13. Federal Authority to Isolate and Quarantine • Federal law requires the reporting of ill passengers on international conveyances (i.e., airplanes, boats) 42 C.F.R. § 71.21 • For example, the commander of an aircraft destined for a U.S. port must report to the quarantine station nearest the airport destination that ill passengers or crew are on board

14. CDC Quarantine Stations

15. Federal Authority to Isolate and Quarantine • When does the federal government step in? • Generally, the CDC defers to state and local public health authorities • However, it uses its authority at points of entry into the United States, in time sensitive settings and on Indian lands and federal reservations (I.e., hospitals, prisons, etc.)

16. Federal Authority to Isolate and Quarantine • Typical Scenarios for federal intervention • International or interstate flight • Certain Indian land • Federal campuses (prisons, hospitals, etc.) • In aid of state public health efforts

17. Federal Authority to Isolate and Quarantine • During the 2003 response to SARS, federal officials: • Provided information to returning air travelers arriving in the United States from areas with SARS, distributing health alert notices advising travelers that they may be been exposed to SARS and how to monitor their health • Boarded airplanes with travelers reported to be ill to assess their symptoms • Facilitated transport of ill passengers to hospitals

18. Federal Authority to Isolate and Quarantine • 2003 Federal Response, continued • Updated government agencies, the travel and the shipping industries and the public • Worked with state and local public health agencies to investigate possible SARS cases

20. Federal Authority to Isolate and Quarantine • Federal power is broad • Public Health Service Act allows individuals to be detained for such time and in such manner as is necessary to protect the public health • Public health officers measure the risk to public health and what can be reasonably done to keep the public health secure • Administrative orders issue with opportunity to challenge through Writ of Habeas Corpus, 28 U.S.C. § 2241, or via Administrative Procedures Act, 5 U.S.C. § 701 et seq.

21. Federal Authority to Isolate and Quarantine • Interplay of Federal and State Authority • Primary responsibility falls on states • Federal authority used to prevent interstate spread and international importation of disease • States and federal government cooperate to enforce federal requirements • Federal government assists states in controlling communicable disease by funding, resources, etc.

22. CDC Division of Quarantine Memoranda of Agreement Minnesota • Minneapolis • Rochester • Roseau • Duluth • International Falls

23. CDC Quarantine Division Memoranda of UnderstandingNorth and South Dakota • South Dakota • Sioux Falls • Pierre • North Dakota • Bismarck • Pembina

24. Federal Authority to Isolate and Quarantine • Key federal cases • Jacobson v. Massachusetts, 197 U.S. 11 (1905) • U.S. ex rel. Siegal v. Shinnick, 219 F.Supp. 789 (E.D.N.Y. 1963)

25. Federal Authority to Isolate and Quarantine • CDC website • http://www.cdc.gov/ncidod