Title: Public Health Law
1Public Health Law
- BIO-TERRORISM
- Robert Kaman, JD, PhD
2KILL ONE,
FRIGHTEN 10,000
-- Tom Clancy The Sum of All Fears
3The Failure of the Public Health Response
- Pearl Harbor all over again? Following 9-11 and
the Afghanistan attacks, we were subjected to an
anthrax attack. - Health officials did not realize that powder as
fine as chalk dust might leak from an envelope - Postal workers were not tested and treated as
quickly as congressional staffers - Public statements about the size and hazards of
the spores were inconsistent and confusing - Still no guilty parties identified
4Isolated case, or symptomatic of a failed system?
- Fifty years of decreasing commitment to an
effective public health system. - Liberals viewed public protection as an attack on
civil liberty - Conservatives have opposed government funding of
medical services, viewing it as a personal choice - Different reasons, but the same effect
- An absence of political support for public health
programs and institutions.
5What do we have now?
- Ill-funded system
- Fragmented
- Highly respectful of personal choice
- Founded on antiquated laws which actually thwart
decisive public health action - They often prohibit data-sharing between public
health, law enforcement and emergency management
agencies - They do not provide adequate powers for
controlling property and persons in the event of
bio-terrorism. - Unprepared for a nationally-coordinated response
to crisis.
6Example Public Health Response to AIDS
- Minimal intrusion on personal autonomy and
privacy - Government viewed as a threat rather than a
solution - Civil-libertarian response to AIDS is reflective
of the individualism and the cult of the
entrepreneur that has predominated in American
society for the past twenty years
7The Threat
- In an era of intercontinental travel, the US is
vulnerable to epidemics of potentially massive
proportion - Anthrax
- Multi-drug resistant tuberculosis
- AIDS
- West Nile Virus
- Smallpox
- Ebola
- SARS
8Solution? New Federal and State Laws
- Mobilization of needed resources and the
permission - no the requirement to share
information and to establish interagency (public
health, law enforcement, emergency management)
cooperation - Effective utilization of the medical technology
we possess (antibiotics, vaccines, other
biological security measures) to cope with the
threats that we will face - Willingness to sacrifice certain virtues of
personal autonomy against the larger backdrop of
the common good.
9Federal Programs
? Domestic Preparedness - Interagency effort
directed by Congress - AKA Nunn-Lugar
Domenici City Training ? Consequence Management
Program - Department of Defense efforts
directed by SECDEF - Improve Department
of Defense support for response to WMD
attacks - Integrate National Guard and
Reserve components
10STATE PROGRAMSThe Model State Emergency Health
Powers Act (MSEHPA)
- Principal Author Lawrence O. Gostin, JD
- Professor and Director
- Center for Law and the Publics Health
- Georgetown University Law Center, Johns Hopkins
University and the CDC - Washington, DC
11MSEHPA
- Five basic public health functions to be
facilitated by the MSEHPA - Preparedness
- Takes effect immediately
- Surveillance
- Takes effect immediately
- Management of Property
- Takes effect only after governor declares
emergency - Protection of Persons
- Takes effect only after governor declares
emergency - Public Information and Communication
12What is a Public Health Emergency?
- The occurrence of imminent threat of an illness
or health condition caused by bio-terrorism or a
novel or previously controlled or eradicated
infectious agent or biological toxin. The health
threat must pose a high probability of a large
number of deaths or serious disabilities in the
population.
13MSEHPA
- Facilitates systematic planning for a public
health emergency - Coordination of services
- Procurement of vaccines and pharmaceuticals
- Housing, feeding and caring for affected
populations appropriate to physical, cultural
and social needs - Proper vaccination and treatment of individuals
- Authority for surveillance of health threats
- Continuing power to follow a developing public
health emergency.
14MSEHPA
- Requires prompt reporting by health care
providers, pharmacists, veterinarians, and
laboratories - Provides for exchange of relevant data among lead
agencies such as public health, emergency
management and public safety - Comprehensive power to manage property and to
protect persons, and to safeguard the publics
health and security
15MSEHPA
- Authority to close, decontaminate or procure
facilities and materials to respond to a public
health emergency - Safely dispose of infectious waste
- Obtain and deploy health care supplies
- Physically examine or test individuals as
necessary for diagnosis or treatment - Vaccinate or quarantine individuals to prevent
transmission of contagious disease - Waive licensing requirements to facilitate
treatment
16MSEHPA
- Provides for a set of post-declaration powers and
duties to ensure appropriate public information
and communication.
17MSEHPA
- Creates a Public Health Emergency Planning
Commission which - Must deliver a plan for responding to a public
health emergency within six months of its
formation. - Fifteen or more elements
- declaration,
- central coordination,
- organization of resources,
- compliance with reporting requirements,
- engagement of the judicial system,
- population evacuation,
- housing and feeding plan,
- organization of personnel,
- vaccination,
- treatment of persons exposed,
- disposal of infectious waste and human remains,
- isolation and quarantine plan,
- tracking,
- involvement of city and county government in the
above, - cultural, ethnic and religious relevance plan,
- other measures that may be deemed necessary.
18MSEHPA
- Declaration of a Public Health Emergency
- Governor declares
- Content
- The nature of the emergency
- The political subdivisions or geographic areas
involved - The conditions that have caused the emergency
- The duration of the emergency, if less than 30
days - The primary public health authority responding
19MSEHPA
- Effect of the Declaration activation of the plan
- Emergency powers
- Coordination of resources
- Personnel identification
- Enforcement
- Public health authority may request from public
safety and militia
20MSEHPA
- Measures to Detect and Track Public Health
Emergencies - Reporting
- Illness or health condition
- Pharmacists
- Manner of reporting
- Animal diseases
- Laboratories
- Enforcement
21MSEHPA
- Tracking
- Identification of individuals
- Interviewing individuals
- Examination of facilities or materials
- Enforcement
- Information Sharing
- Public safety authority must notify the public
health authority, and vice versa upon evidence of
a possible public health emergency - Information restricted to the minimum required
22MSEHPA
- Special Powers
- Management of Property
- Facilities
- Materials
- Access to and control of facilities and property
- Use of materials and facilities
- Use of health care facilities
- Control of materials
- Control of roads and public areas
23MSEHPA
- Safe Disposal of Infectious Waste
- Adopt measures
- Control facilities
- Use of facilities
- Identification of waste
- Safe Disposal of Human Remains
- Adopt measures
- Possession
- Disposal
- Control and use of facilities
- Labeling
- Identification
24MSEHPA
- Control of Health Care Supplies
- Procurement
- Rationing
- Priority
- Distribution
- Compensation
- Destruction of property
25MSEHPA
- Special Powers Protection of Persons
- Medical examination and testing
- Vaccination and treatment
- Isolation and quarantine
- Authorization
- Conditions and principles
- Least restrictive
- Isolated persons separated from quarantined
persons - Health status monitored
- Immediate release upon elimination of risk
- Cooperation
- Entry into isolation or quarantine premises
- Authorized entry only
- Extensive further considerations
26MSEHPA
- Collection of Samples for Testing
- Marking
- Contamination
- Chain of custody
- Criminal investigation
- Access to and Disclosure of Protected Health
Information
27MSEHPA
- Licensing and Appointment of Health Personnel
- Health care providers must serve as a condition
of state licensing - Health care providers from other jurisdictions
licensing waived - Appointment of medical examiner or coroner
28MSEHPA
- Public Information Regarding Public Health
Emergency - Dissemination of Information
- Means of dissemination
- Languages
- Accessibility to persons with disabilities
- Access to mental health support personnel
29MSEHPA
- Miscellaneous
- Rules and regulations by public health authority
- Financing and expenses
- Transfer of funds
- Repayment Conditions
- Expenses authorized
- Liability and immunity
- Compensation
30MSEHPA
- Termination of Declaration
- Executive Order
- Automatic Termination
- State Legislature
- Content of termination order
31MSEHPA
- What will Texas do? Senate Bill 399 was
introduced by Letitia van Puttin in the Spring of
2003, based on the MSEHPA. - An act relating to the powers of the governor
and certain state agencies relating to public
health, including public health emergencies. - The legislature failed to vote on the final bill,
and it was not added to the special session
agenda. - Texas did pass a homeland security bill, which
contains some elements of the MSEHPA
32Local Actions
- Tarrant County Public Health Department created
three 3-member Health Response Teams (HRTs) to
respond to bio-terrorism - Investigation, assessment and coordination of
response to suspected bio-terrorism - Coordinate response with law enforcement and
hazmat officials - Receive and deliver bio-terrorism training on
medical recognition of signs and symptoms of
biological agents
33(No Transcript)
34RECOMMENDATIONS
- Be aware
- Do not over-react
- Listen to authorities
- Take common sense precautions
- - radio and batteries
- - 3 - 5 day supply of food and water
- - full tank of gas
- - location of shelters
- Participate in planning
- Continue usual behavior
- Follow the upcoming legislature look for the
- reintroduction of a bill similar to SB 399