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Pandemic Influenza Legal Preparedness. Comstock.com. CDC. Comstock.com. This course was made possible by cooperative agreement number U90/CCU324238 from the Centers for Disease Control and Prevention

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pandemic influenza legal preparedness
Pandemic Influenza Legal Preparedness

Comstock.com

CDC

Comstock.com

This course was made possible by cooperative agreement number U90/CCU324238 from the Centers for Disease Control and Prevention

Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

slide2

Pandemic Influenza Legal Preparedness

Patricia M. Sweeney, JD, MPH, RN

Department of Health Policy and Management

Graduate School of Public Health

University of Pittsburgh

Center for Public Health Preparedness

[email protected]

public health emergencies
Floods

Fires

Winter storms/summer heat

Hurricanes, tornados

Mine subsidence, landslides

Power outages

Water emergencies

Hazardous materials spills

Transportation accidents

Industrial accidents/ releases

Earthquakes / Tsunami

CBRNE-terrorism

Pandemic Influenza

Public Health Emergencies
1918 influenza pandemic h1n1
1918 Influenza Pandemic - H1N1
  • 25% morbidity
  • 2.5 % mortality
    • 675,000 U.S.
    • 50-100 million worldwide
  • US life expectancy
    • dropped > 10 years
  • More deaths than
    • World Wars I and II and Korean war combined
  • More deaths in
    • one year than the Black Death killed in a century
    • 24 weeks than AIDS/HIV deaths in 24 years
  • Comparable deaths today
    • 1,750,000 U.S.
    • 180-360 million worldwide
influenza pandemic today
Influenza Pandemic Today
  • CDC – result of “moderate” U.S, epidemic
    • 89,000 to 207,000 deaths
    • 314,000 to 734,000 hospitalizations
    • 18 to 42 million outpatient visits
    • 20 to 47 million people sick at home.
  • Up to 35% of the U.S. population affected
  • Economic impact between $71.3 and $166.5 billion.
impact of pandemic influenza upon social networks
Impact of Pandemic Influenza upon Social Networks
  • 25% of workers do not report
  • “Essential systems” crippled
    • Transportation
    • Food supply
    • Communications
  • Morgues exceed capacity
  • Entire families are ill; unable to care for each other
spread in less than 30 days
Spread in less than 30 days!

Source: PBS, WGBH American Experience :Influenza 1918 www.pbs.org/wgbh/amex/influenza/maps

slide9

Pandemic Influenza

Legal Preparedness

  • Identify the source and scope of public health legal authority

2. Identify public health law issues that arise with pandemic influenza

3. Describe steps being taken to improve legal preparedness for pandemic influenza

Learning Objectives

slide10

Pandemic Influenza

Legal Preparedness

Occurring on the international, federal, state, and local levels

Comstock.com

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Pandemic Influenza

Legal Preparedness

Based upon traditional public health legal authority

Comstock.com

review federal public health legal authority
Review: Federal Public Health Legal Authority
  • United States Constitution
  • Article I § 8
  • Levy taxes
  • Regulate commerce between the states

Comstock.com

examples federal public health legal authority
Examples: Federal Public Health Legal Authority
  • The Occupational Safety and Health Act of 197029 USCS § 651 et. seq.
  • The Food, Drug and Cosmetic Act21 USCS § 321 et. Seq.
  • The Fair Labor Standards Act of 193929 USCS § 201 et.seq.
  • More…..
review state public health legal authority
Review:State Public Health Legal Authority

United States Constitution

10th Amendment

Police Power

Federal

Government

Sovereign

states

Comstock.com

slide15

State Public Health Authority

  • Statutes
  • State Department of Health (Pa DOH) regulations
  • State DOH orders
  • Local DOH ordinances, resolutions and orders
state public health legal authority
State Public Health Legal Authority

Pennsylvania Disease Prevention and Control Act of 1955 35 P.S. §521 et. seq.

Administrative Code 16 P.S.§12001 et seq.

Local Health Administration Law Chapter 28

  • Regulate persons, businesses and professions
  • Control nuisances and dangerous conditions
  • Create a local health department infrastructure
  • Control communicable disease

Photodisc/Health and Medicine/Getty Images

slide18
Pennsylvania Disease Prevention and Control Act

Communicable Disease Control

Department can use surveillance, segregation,

quarantine or modified quarantine of contacts of a

person or animal with a communicable disease or

infection, OR ANY OTHER APPROPRIATE DISEASE

CONTROL MEASURE NECESSARY TO PROTECT

THE PUBLIC FROM THE SPREAD OF INFECTIOUS AGENTS.20 Pa. Code §27.60(a) (2006)

slide19
Pennsylvania Disease Prevention and Control Act

Order Medical Examinations

With reasonable grounds to suspect a person is infected with a communicable disease or is a carrier, the DOH or County/Municipal department of health may require the individual to submit to a medical examination or any other approved diagnostic procedure.

20 Pa. Code §27.81(a) (2006); 35 Pa Cons. Stat. § 521.7 (2005).

slide20
Pennsylvania Disease Prevention and Control Act

If Order For Medical Treatment Is Refused

The Pennsylvania DOH or County/Municipal departments of health can seek a court order to compel the medical treatment orisolate the infected person until the disease is no longer communicable.

35 Pa Cons. Stat. § 521.11(a.1) (2005).

slide21
Pennsylvania Disease Prevention and Control Act

Contact Investigation and Quarantine Authority

The Pennsylvania DOH or County/Municipal department of health is required to investigate disease outbreaks and is authorized to quarantine case contacts.

28 Pa. Code § 27.65; 28 Pa. Code § 27.152

pennsylvania public health legal authority
Pennsylvania Public Health Legal Authority

Take Private Property

Governor, Secretary of Health,

County Municipal Health Departments

and Local Health Authorities

may temporarily close, Commandeer (Governor) and/or Evacuate private property

Even schools 35 Pa Cons Stat. 7701(d)

ohio public health legal authority
Ohio Public Health Legal Authority
  • Title 37 Health – Safety – Morals
  • Ohio Dangerous Communicable Disease LawORC Ann. § 3707.04
  • Local Health Department Administration and Director: Communicable Disease Control

OAC Ann. § 3701-36-06

  • Establishment of Health DistrictsORC Ann. 3709.1

Photodisc/Health and Medicine/Getty Images

slide24
Ohio Public Health Legal Authority

Dangerous Communicable Disease Control

The Department shall have the ultimate authority in matters of quarantine and isolation.

The department may take actions as necessary to encourage vaccination against specified diseases.

ORC Ann. § 3701.13 (2006)

slide25
Ohio Public Health Legal Authority

Quarantine of persons exposed to communicable disease

When a person known to have been exposed to a communicable disease is declared quarantinable, the board will restrict this person to his place of residence or other suitable place, prohibit entrance to or exit from such place without the board’s written permission in order to preventcontact with others not exposed, and enforce restrictive measures prescribed by the department.

ORC Ann. § 3707.08

slide26
Ohio Public Health Legal Authority

The Department of Health and local departments of health have the authority to control all reported cases of communicable disease by ensuring

  • Appropriate and adequate treatment
  • Isolation and disinfection
  • Contact tracing

OAC Ann. § 3701-36-06

Chapter 3701-36

Local Health Departments  OAC Ann. 3701-36-06

federal public health authority disease control
Federal Public Health Authority Disease Control

The federal government

has the authority to prevent introduction, transmission and

spread of communicable disease.

42 USCS § 264 et seq; 40 CFR 70.2

federal public health authority apprehend and examine
Federal Public Health Authority Apprehend and Examine

The is authorized to

apprehend and examine individuals reasonably believed

to be infected with a communicable disease

in a communicable state,

who are coming into the country or

moving from state to state.

42 USCS 264(d)(1)

federal public health authority apprehend and detain
Federal Public Health Authority Apprehend and Detain

Lists diseases subject to

apprehension, detention and

conditional release of individuals.

Executive Order 13295 April 3, 2003.

Amended April 2005

“Influenza caused by novel or re-emergent influenza viruses that are causing, or have the potential to cause, a pandemic."

state and federal public health powers
State and Federal Public Health Powers
  • Examine
  • Isolate ill
  • Quarantine exposed
  • Mandate treatment
  • Use private property
limitations to public health legal authority
Limitations to Public Health Legal Authority

United States Constitution 4th Amendment

Right to Privacy

Permits only reasonable search and seizure with warrants upon probable cause

limitations to public health legal authority1
Limitations to Public Health Legal Authority

United States Constitution 5th Amendment

Due Process

Federal Government cannot deny civil liberties without Due Process of law

Requires both Substantive and Procedural Due Process

limitations to public health legal authority2
Limitations to Public Health Legal Authority

United States Constitution 14th Amendment

Due Process

Made due process apply to states

Established Equal Protection -

Government action must treat similarly situated people similarly

analysis
Analysis

Public Health ordered vaccination or treatment

Permitted by

Jacobson v. Massachusetts 197 US 11 197 US 11 (1904)

Constrained by

Due process

Equal protection

Consent

Washington v. Glucksberg521 U.S. 702 (1997)

analysis1
Analysis

Public Health ordered isolation, quarantine

and/or detention for treatment

Permitted by

state and federal public health law

Best v. St. Vincent’s Hospital2003 U.S. Dist. LEXIS 13188

United States District Court Southern District NY

Constrained by

Civil liberties

Due process

Equal protection

Best v. St. Vincent’s Hospital2003 U.S. Dist. LEXIS 13188

United States District Court Southern District NY

analysis2
Analysis

Restriction upon liberties must be

“ least restrictive means”

Shelton v. Tucker, 364 U.S. 479 (1960)

Law enforcement monitoring

Mandatory quarantine

Telephone monitoring

Voluntary quarantine

Snow day

Mask and gloves

analysis3
Analysis

Public Health ordered property “taking “

Permitted by

Government necessity

Penn Central Transp. Co. v City of New York

438 US 104 (1978)

Constrained by

Civil liberties

Due process

Equal protection

Machipong Land & Coal Co. v. Commonwealth

799 A2d 751 (pa. 2002)

slide39

Model State Emergency Health Powers Act (MSEHPA)http://www.publichealthlaw.net/MSEHPA/MSEHPA2.pdfand http://www.publichealthlaw.net/MSEHPA/MSEHPA%20Surveillance.pdf

Draft legislation

Model for states to assess

legal preparedness for public health emergencies

legal preparedness
Legal Preparedness
  • Adequacy of relevant legal authorities
  • Accessibility of legal information to public health officials
  • Competency of public health officials applying the relevant laws
  • Ability of public health officials to coordinate actions
    • Across jurisdictions
    • Across government agencies and private sector
legal preparedness1
Legal Preparedness =
  • Become familiar with the public health legal authorities in your jurisdiction
  • Identify and address legal issues in advance
  • Draft documents in advance
  • Plan due process procedures
  • Engage the courts in advance
pandemic influenza legal preparedness activities
Pandemic Influenza Legal Preparedness Activities
  • Legal Preparedness Manuals
  • Public Health Law Benchbooks
  • Public Health Emergency Law Training
  • Pandemic Influenza Table Top Exercises
  • Courthouse Preparedness for Public Health Emergencies
new issue
New Issue

Business preparedness for pandemic influenza

Adapted from a presentation by

Jeffrey P. Clark, Esq.

Reinhart Boerner Van Deuren s.c.

1000 North Water Street

Milwaukee, WI 53202

July 13, 2006

business preparedness for pandemic influenza legal issues
Business Preparedness for Pandemic Influenza – Legal Issues

Legal standard of care in crisis

  • National Standard
    • National Standard of Disaster Management and Business Continuity Programs NFPA 1600
    • Requires businesses to
      • Mitigate
      • Prepare for
      • Respond to
      • Recover from disasters and emergencies
  • State negligence standard
    • Ordinary care
business preparedness for pandemic influenza legal issues1
Business Preparedness for Pandemic Influenza – Legal Issues

Threats to business in a crisis

  • Potential plaintiffs
    • Employees
    • Patients or visitors
    • Customers
    • Shareholders
    • Suppliers
    • Labor unions
major legal issues for businesses
Major Legal Issues for Businesses
  • OSHA
  • Worker’s Compensation
  • Family Medical Leave Act
  • ADA
  • Health Benefits
  • Labor Agreements
  • Confidentiality
business preparedness for pandemic influenza
Business Preparedness for Pandemic influenza
  • Review all healthcare, disability and workers’ compensation coverage
  • Business interruption insurance
  • Review absenteeism policies
  • Develop Continuation Of Operations Plans
pandemic influenza legal preparedness activities and resources
Pandemic Influenza Legal Preparedness Activities and Resources
  • Community Containment of SARS http://www.cdc.gov/ncidod/sars/quarantine.htm
  • National Association of City and County Health Officials (NACCHO) pandemic influenza site http://www.naccho.org/topics/infectious/emerging/avian.cfm
  • HHS pandemic influenza planning updates http://www.pandemicflu.gov/plan/pdf/panflu20060313.pdf , http://www.astho.org/pubs/panflureport2HHS.pdf
  • Executive Order identifying quarantinable communicable diseases http://www.whitehouse.gov/news/releases/2005/04/20050401-6.html
  • DHHS Office of Civil Rights – HIPAA Privacy Rule: Disclosures for Emergency Preparedness. A Decision Tool http://www.hhs.gov/ocr/hipaa/decisiontool/
pandemic influenza legal preparedness activities and resources1
Pandemic Influenza Legal Preparedness Activities and Resources
  • Pandemicflu.gov
  • Avainflu.gov
  • Homeland Security Law Handbook.ABS Consulting. Government Institutes, Rockville Maryland. 2003.
  • Terrorism and Disaster Management : Preparing Healthcare Leaders for the New Reality. McGlown, K., Health Administration Press. Chicago 2004 http://www.bepress.com/cgi/viewcontent.cgi?article=1084&context=jhsem
  • World Health Organization Pandemic Influenza Plan http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2005_5/en/
  • CDC Privacy Rule recommendations http://www.cdc.gov/privacyrule/Guidance/Content.htm
pandemic influenza legal preparedness activities and resources2
Pandemic Influenza Legal Preparedness Activities and Resources
  • CDC Public Health Emergency Law Training Coursehttp://www2a.cdc.gov/phlp/phel.asp
  • Legal Authorities Index for National Pandemic Influenza Response Planhttp://www2a.cdc.gov/phlp/docs/Appendix%20C%20from%20nspi_implementation.pdf
  • Indiana Public Health Law Benchbookhttp://www.publichealthlaw.info/INBenchBook.pdf
  • Pandemic Influenza Checklists for government, business, families, health care centers, community organizationshttp://www.pandemicflu.gov/plan/checklists.html
  • Pandemic Influenza and Public Health Law Training (California)http://cdlhn.com/create_frameset.cfm?id=28&CFID=609037&CFTOKEN =29640636
  • CDC Public Health Law Program

http://www.phppo.cdc.gov/od/phlp/index.asp

  • Fact sheet on Legal Authorities for Isolation/Quarantine http://www.cdc.gov/ncidod/sars/factsheetlegal.htm
  • University of Pittsburgh Center for Public Health Preparedness

http://www.cphp.pitt.edu/upcphp/

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