1. An Introduction to Public Health Law in Texas Anne Kimbol University of Houston Health Law and Policy Institute

2. What is Public Health Law? Intersection between public health professionals and government/regulation Largely deals with authority and the balance between the need to protect the public health and individuals rights

3. Authority in Texas - Federal Police powers v. Commerce Clause. President – communicable disease definition Secretary of HHS/CDC – regulations relating to communicable diseases and help states

4. Authority in Texas - Governor Texas Disaster Act Evacuations Emergency management plan

5. Authority in Texas - DSHS Implementation of communicable disease control measures Declare public health disaster Define reportable diseases Help/preempt local authorities Investigate cases

6. Authority in Texas - Local Local health authority is in charge of control measures locally and most communication between locals and DSHS Authority generally overlaps with DSHS but with area limitations For certain actions, LHA must consult DSHS

7. Authority in Texas - Courts Courts largely play a role of ensuring adequate balance between public safety and individual rights Mostly get involved when a party refuses to comply with an order from the LHA or DSHS

8. Reportable Diseases - Who? DentistsVets Local school authorities Person in charge of clinical or hospital lab, blood bank, mobile unit, or other facility performing labs RN Administrator or director of nursing home, personal care home, maternity home, adult respite care center, adult day-care center, home health agency, institution of higher ed, public or private camp, home, or institution, correctional institution Owner or manager of restaurant, dairy, other good handling or processing place EMT Peace officer Firefighter

9. Reportable Disease – What And When? Defined by DSHS http://www.dshs.state. tx.us/idcu/investigatio n/conditions/ http://www.dshs.state. tx.us/idcu/investigatio n/conditions/ Additional organisms Information to be reported

10. Reportable Diseases - Animals Multiple species diseases Akabane - Akabane virus Akabane - Akabane virus Anthrax** - Bacillus anthracis Anthrax** - Bacillus anthracis Aujeszkys disease - Pseudorabies virus, herpesvirus suis Aujeszkys disease - Pseudorabies virus, herpesvirus suis Leishmaniasis** - Leishmania infantum and L donavani Leishmaniasis** - Leishmania infantum and L donavani Foot and mouth disease - Aphthovirus, types A,O,C, SAT, Asia Foot and mouth disease - Aphthovirus, types A,O,C, SAT, Asia Heartworm - Cowdria ruminantium Heartworm - Cowdria ruminantium African Trypanosomosis (Nagana) - Trypanosoma brucei, T. vivax, African Trypanosomosis (Nagana) - Trypanosoma brucei, T. vivax, T. brucei T. brucei Rinderpest - Morbillivirus Rinderpest - Morbillivirus Rift Valley fever - Bunya virus Rift Valley fever - Bunya virus Vesicular stomatitis - Rhabdovirus; 2 serotypes; New Jersey and Indiana Vesicular stomatitis - Rhabdovirus; 2 serotypes; New Jersey and Indiana Screwworm - Cochliomyia hominivorax Screwworm - Cochliomyia hominivorax Cattle diseases (including Exotic Bovidae) Bovine babesiosis - B. bovis, B. divergens, Babesia microti Bovine babesiosis - B. bovis, B. divergens, Babesia microti Bovine brucellosis - Brucella abortus Bovine brucellosis - Brucella abortus Bovine ephemeral fever - Rhabdovirus Bovine ephemeral fever - Rhabdovirus Bovine tuberculosis - Mycobacterium bovis Bovine tuberculosis - Mycobacterium bovis East coast fever (Theileriosis) - Theileria parva East coast fever (Theileriosis) - Theileria parva Malignant catarrhal fever (wildebeest associated) – Alcelaphine herpesvirus (AHV 1) Malignant catarrhal fever (wildebeest associated) – Alcelaphine herpesvirus (AHV 1) Contagious bovine pleuropneumonia - Mycoplasma mycoides Contagious bovine pleuropneumonia - Mycoplasma mycoides Lumpy skin disease - Neethling poxvirus Lumpy skin disease - Neethling poxvirus Bovine spongiform encephalopathy - Bovine spongiform encephalopathy - Scabies - Sarcoptes scabiei, Psoroptes bovis, Chorioptes bovis Scabies - Sarcoptes scabiei, Psoroptes bovis, Chorioptes bovis

11. Reportable Diseases - Animals Cervidae Brucellosis - Brucella abortus, Brucella suis (biotype 4) Brucellosis - Brucella abortus, Brucella suis (biotype 4) Chronic Wasting Disease - Chronic Wasting Disease - Tuberculosis - Mycobacterium bovis Tuberculosis - Mycobacterium bovis Sheep and goat diseases Caprine and ovine brucellosis (not B. ovis infection) - Brucella melitensis Caprine and ovine brucellosis (not B. ovis infection) - Brucella melitensis Contagious caprine pleuropneumonia - Mycoplasma capri (biotype 78) Contagious caprine pleuropneumonia - Mycoplasma capri (biotype 78) Louping ill - Flavovirus Louping ill - Flavovirus Nairobi sheep disease - Bunyaviridae Nairobi sheep disease - Bunyaviridae Peste des petits ruminants - Morbillivirus, Paramyxoviridae family Peste des petits ruminants - Morbillivirus, Paramyxoviridae family Sheep pox and goat pox - Capripoxvirus Sheep pox and goat pox - Capripoxvirus Scrapie Scrapie Scabies - Sarcoptes scabiei Scabies - Sarcoptes scabiei Equine diseases African horse sickness - Orbivirus African horse sickness - Orbivirus Contagious equine metritis - Tayorella equigenitalis Contagious equine metritis - Tayorella equigenitalis Dourine - Trypanosoma equiperdum Dourine - Trypanosoma equiperdum Epizootic lymphangitis - Histoplasma farciminosum Epizootic lymphangitis - Histoplasma farciminosum Equine encephalomyelitis (Eastern and Western)** - Alphavirus Equine encephalomyelitis (Eastern and Western)** - Alphavirus Equine infectious anemia - Lentivirus Equine infectious anemia - Lentivirus Equine morbillivirus pneumonia - Morbillivirus Equine morbillivirus pneumonia - Morbillivirus Equine piroplasmosis - Babesia equi, B. caballi Equine piroplasmosis - Babesia equi, B. caballi Glanders - Pseudomonas mallei Glanders - Pseudomonas mallei Japanese encephalitis - Flavovirus Japanese encephalitis - Flavovirus Surra - Trypanosoma evansi Surra - Trypanosoma evansi Venezuelan equine encephalomyelitis** - Alphavirus; Togaviridae family Venezuelan equine encephalomyelitis** - Alphavirus; Togaviridae family Equine Viral Arteritis (EVA)* *** Equine Viral Arteritis (EVA)* *** Equine Herpes Virus-1 (EHV-1)* Equine Herpes Virus-1 (EHV-1)*

12. Reportable Diseases - Animals Swine diseases African swine fever - Poxvirus African swine fever - Poxvirus Classical swine fever (hog cholera) - Togovirus Classical swine fever (hog cholera) - Togovirus Pseudorabies - Herpesvirus suis Pseudorabies - Herpesvirus suis Porcine brucellosis - Brucella suis Porcine brucellosis - Brucella suis Swine vesicular disease - Picornavirus Swine vesicular disease - Picornavirus Vesicular Exanthema - Calicivirus Vesicular Exanthema - Calicivirus Poultry diseases Avian influenza - Orthomyxoviruse Avian influenza - Orthomyxoviruse Avian infectious laryngotracheitis - Orthomyxovirus, herpesvirus Avian infectious laryngotracheitis - Orthomyxovirus, herpesvirus Avian tuberculosis - Mycobacterium avium serovars 1,2 Avian tuberculosis - Mycobacterium avium serovars 1,2 Duck virus hepatitis - Picornavirus Duck virus hepatitis - Picornavirus Duck virus enteritis - Herpesvirus Duck virus enteritis - Herpesvirus Fowl typhoid - Salmonella gallinarum Fowl typhoid - Salmonella gallinarum Highly pathogenic avian influenza (fowl plague) - Orthomyxovirus (type H5 or H7) Highly pathogenic avian influenza (fowl plague) - Orthomyxovirus (type H5 or H7) Infectious encephalomyelitis - Arbovirus Infectious encephalomyelitis - Arbovirus Ornithosis (psitticosis) - Chlamydia psittaci Ornithosis (psitticosis) - Chlamydia psittaci Pullorum disease - Salmonella pullorum Pullorum disease - Salmonella pullorum Newcastle disease (VVND) - Paramyxovirus-1 (PMV-1) Newcastle disease (VVND) - Paramyxovirus-1 (PMV-1) Paramyxovirus infections (other than Newcastle disease) - PMV-2 to PMV-9 Paramyxovirus infections (other than Newcastle disease) - PMV-2 to PMV-9 Rabbit diseases Myxomatosis - Myxomatosis virus Myxomatosis - Myxomatosis virus Viral haemorrhagic disease of rabbits - Calciviral disease Viral haemorrhagic disease of rabbits - Calciviral disease *These diseases will only be reportable through the last day of the 81st Texas Legislative Session unless continued in effect by act of the legislature. **These diseases are also reportable to the Department of State Health Services (DSHS) ***This disease has reporting standards in Chapter 49, §49.4 of this title (relating to Equine Viral Arteritis (EVA): Reporting and Handling for Breeding of Infected Equine).

13. Reportable Diseases – Where? To DSHS or Local Health Authority Local Health Authority must report to DSHS Texas Animal Health Commission

14. Reportable Diseases – Why? Tracking Class B Misdemeanor Liability protection for good faith reporting Protection of those handling dead bodies

15. Communicable Diseases - Schools LHA may close school if needed to protect public health Exclusionary conditions Amebiasis Amebiasis Campylobacteriosis Campylobacteriosis Chickenpox Amebiasis Chickenpox Amebiasis Common cold Common cold Conjunctivitis, bacterial and/or viral Conjunctivitis, bacterial and/or viral Fever Fever Fifth disease Fifth disease Gastroenteritis Gastroenteritis Giardiasis Giardiasis Head lice Head lice Hepatitis A Hepatitis A Impetigo Impetigo Infections mononucleosis Infections mononucleosis Influenza Influenza Measles Measles Meningitis bacterial Meningitis bacterial Mumps Mumps Whopping cough Whopping cough Ringworm Ringworm Rubella Rubella Salmonellosis Salmonellosis Scabies Scabies Shigellosis Shigellosis Streptococcal sore throat and scarlet fever Streptococcal sore throat and scarlet fever – until antibiotic treatment has begun and physician certificate or health permit is obtained – until antibiotic treatment has begun and physician certificate or health permit is obtained

16. Quarantine and Isolation - Terms Quarantine Not defined in Texas H&S Code Not defined in Texas H&S Code PH definition – Separation and restriction of movement of individuals who are not yet ill but have been exposed to a communicable disease PH definition – Separation and restriction of movement of individuals who are not yet ill but have been exposed to a communicable diseaseIsolation Also not defined in law Also not defined in law Separation of individuals ill with a communicable disease Separation of individuals ill with a communicable disease Terms are often used interchangeably in law

17. Quarantine and Isolation - Property

18. Q&I – Property - DSHS Right of entry Samples Impose control measures Quarantine Quarantine Restrict access Restrict access Destruction Destruction

19. Q&I – Property – LHA Same as DSHS within region

20. Q&I – Property – Courts PenaltiesEnforcement

21. Quarantine and Isolation - Carriers

22. Q&I – Carriers - DSHS Order the vehicle stopped Get information on people aboard Impose control measures

23. Q&I – Carriers – LHA Same as DSHS

24. Q&I – Carriers - Courts PenaltiesEnforcement

25. Quarantine and Isolation - Areas

26. Q&I – Areas – DSHS QuarantineInvestigations Work with neighboring states Publish notice Obtain immunization records

27. Q&I – Areas – LHA Quarantine after DSHS consult Written notice Governing body Governing body Public Public Designate facilities

28. Q&I – Area – Courts PenaltiesEnforcement Suspend admission of patients seeking elective treatment

29. Quarantine and Isolation - People

31. Q&I – People – DSHS Preempt LHA Return other states residents Impose control measures Individuals Individuals Groups Groups

32. Q&I – People – LHA Same as DSHS

33. Q&I – People – Courts Penalties Different types/levels/procedures for enforcement Order for Management of Person with a Communicable Disease Order for Management of Person with a Communicable DiseaseTemporaryExtended Protective Custody Orders Protective Custody Orders

34. Q&I – People – Courts – PCO Motion for Order for temporary protective custody Order for TPC Motion for Order for Protective Custody Attorney Probable Cause hearing Court order – continued detention or release

35. Q&I – People – Courts – OMPCD Application Appointment of attorney TimingNoticeRecommendationsHearing Court decision – release, outpatient, temporary, extended

36. Q&I – People – Modifications CauseNoticeHearingDetentionCounsel Court decision

37. Q&I – People – Renewal For extended management order ApplicationAffidavitAttorneyHearing

38. Q&I – People – Rehearings RehearingAppealExaminationTiming

39. Q&I – People – Treatment Facility Temporary Passes Release/discharge

40. Q&I – People – Groups Any statement or determination regarding the conduct of a member of the group must apply to the majority of its members; Any finding or statement regarding compliance must apply to all members of the group; Any notice being sent to the group must also be published in the local newspaper of general circulation, state that the group is appointed one attorney but any individual member may request an individual attorney, and include instructions for people who suspect they may be part of the group to contact DSHS or the LHA.

41. Rabies A reportable condition in humans and animals For animals Report within one working day of diagnosis for animal Report within one working day of diagnosis for animal Report to regional zoonosis control office of Zoonosis Control Division in Austin Report to regional zoonosis control office of Zoonosis Control Division in Austin For humans – report immediately to LHA or DSHS regional director (considered public health emergency)

42. Rabies – DSHS H&S Code Chapter 826 Set minimum standards Provide vaccine or serum Adopt control measure rules Hold hearings Regulate facilities Override locals

43. Rabies – Local/Professionals Local rabies control authority Animal licensing Quarantine and other control measures Liability protection for veterinarians Exemptions for police dogs Penalties for facilities Rabies biologicals

44. Rabies – Individuals Vaccinate cats and dogs Penalties for failure Penalties for failure Reporting of suspected rabies and/or possible transmission to humans

45. Rabies – Area Quarantines Area quarantine if rabies exists in an area Borders and rules adopted Restraint provisions Penalty for failure to comply

46. Contact Information; Other UH Health Law and Policy Institute will be releasing a bench book for judges on isolation and quarantine issues. Will include charts shown here as well as sample forms and simplified language summarizing the key statutes. Anne Kimbol, askimbol@central.uh.edu, 713-743-2198

47. Further Contacts/Information FEDERAL Centers for Disease Control and Prevention (800) CDC-INFO Centers for Disease Control and Prevention (800) CDC-INFO Federal Emergency Management Agency (800) 621-FEMA Federal Emergency Management Agency (800) 621-FEMA National Institutes of Health (301) 496-4000 National Institutes of Health (301) 496-4000 Office of the Surgeon General (301) 443-4000 Office of the Surgeon General (301) 443-4000 Public Health Service Commissioned Corps (240) 453-6000 Public Health Service Commissioned Corps (240) 453-6000STATE Commissioner of Health (888) 963-7111 Commissioner of Health (888) 963-7111 Governors Office (800) 843-5789 Governors Office (800) 843-5789 Office of General Counsel, TDSHS (512) 458-7236 Office of General Counsel, TDSHS (512) 458-7236 Office of Public Health Practice, TDSHS (512) 458-7700 Office of Public Health Practice, TDSHS (512) 458-7700 Center for Public Health Preparedness and Response, TDSHS (512) 458-7219 Center for Public Health Preparedness and Response, TDSHS (512) 458-7219

48. Further Contacts/Information SUGGESTED LOCAL CONTACTS County Commissioners Court County Commissioners Court County and/or municipal departments of health County and/or municipal departments of health City Council City Council City Attorneys Office City Attorneys Office Local office of public health preparedness Local office of public health preparedness County Attorney County Attorney County Appraisal District County Appraisal District Information Available on the Internet Centers for Disease Control and Prevention http://www.cdc.gov/ Centers for Disease Control and Prevention http://www.cdc.gov/ Federal Emergency Management Agency http://www.fema.gov/ Federal Emergency Management Agency http://www.fema.gov/ National Institutes of Health http://www.nih.gov/ National Institutes of Health http://www.nih.gov/ Governors Office http:///www.governor.state.tx.us Governors Office http:///www.governor.state.tx.us Texas Department of State Health Services http://www.dshs.state.tx.us Texas Department of State Health Services http://www.dshs.state.tx.us Communicable Disease Control Measures in Texas, DSHS Report http://www.dshs.state.tx.us/comprep/ogc/cdmanual.pdf Communicable Disease Control Measures in Texas, DSHS Report http://www.dshs.state.tx.us/comprep/ogc/cdmanual.pdf Avian Flu Pandemic Litigation Forms, Office of the Attorney General http://www.oag.state.tx.us/notice/emergency /birdflu/index_forms.php Avian Flu Pandemic Litigation Forms, Office of the Attorney General http://www.oag.state.tx.us/notice/emergency /birdflu/index_forms.php