1. Bioterrorism, Communicable Diseases, and the Courts Conference of Superior Court Judges June 20, 2003

2. House Bill 1508 Communicable Disease Outbreaks N.C. Gen. Stat. § 130A-145 Suspected Terrorist Attacks (STA) N.C. Gen. Stat. § 130A-475 –Nuclear, Biological, or Chemical (NBC)

3. Communicable Disease N.C. Gen. Stat. § 130A-2 – an illness due to an infectious agent transmitted from an infected person or animal through an intermediary. * Communicable condition – being infected without symptoms

4. Communicable Diseases N.C. Gen. Stat. § 130A-145 Both State Health Director (SHD) and Local Health Directors (LHDs) have authority in outbreak situations to issue Orders. Isolation and Quarantine Orders

5. Communicable Diseases N.C. Gen. Stat. § 130A-145 SHD/LHDs have quarantine/isolation authority when The public health is actually endangered All other reasonable means have been exhausted No less restrictive alternative exists

6. Communicable Diseases N.C. Gen. Stat. § 130A-145 Isolation Order (§ 130A-2) limits freedom of movement or action of person or animal who actually has disease or condition Freedom of movement – stay at home, can’t go certain places. Freedom of action – restricts behavior, but not where you can go.

7. Communicable Diseases N.C. Gen. Stat. § 130A-145 Quarantine Order (§ 130A-2) limits freedom of movement/action of person/animal that has been/is reasonably suspected to have been exposed to communicable disease or condition limits access to areas that may be contaminated with an “infectious agent”

8. Communicable Diseases N.C. Gen. Stat. § 130A-145 Quarantine Order (continued): limit freedom of movement/action of people who are not immunized (does not apply to animals) - § 130A-157 – there is a religious exemption to immunization laws, but not to SHD/LHD Order

9. Communicable Diseases N.C. Gen. Stat. § 130A-145 A person who is “substantially affected” by Order may petition to Superior Court for review of the Order. Can be filed either where limitations are imposed, or in Wake County Hearing within 72 hours (no weekends) Chapter 7A – court-appointed lawyer

10. Communicable Diseases N.C. Gen. Stat. § 130A-145 Burden on “substantially affected” person to show by a preponderance that limitations are not “reasonably necessary to prevent or limit the conveyance of a communicable disease to others” * If burden is met, then court shall reduce the limitations.

11. Communicable Diseases N.C. Gen. Stat. § 130A-145 SHD/LHD Communicable Disease Orders: Initial Order only valid for ten days (unless Order limits freedom of action) To extend the Order: petition Superior Court (where limitations are/Wake) prior to expiration of the Order

12. Communicable Diseases N.C. Gen. Stat. § 130A-145 Extension: Burden on SHD/LHD to show by a preponderance that extension is “reasonably necessary to prevent or limit conveyance of disease or condition to others” Extension period for up to 30 days; SHD/LHD can file subsequent petitions.

13. Communicable Diseases N.C. Gen. Stat. § 130A-145 Judicial modification of SHD/LHDs Orders: Judge MUST make specific findings about the reasonable necessity (or lack thereof) of the limitations “to prevent or limit conveyance of communicable disease or condition” to modify Order.

14. Suspected Terrorist Attacks N.C. Gen. Stat. § 130A-475 ONLY SHD (not LHD) may enter STA Orders. SHD has STA authority when - Public health threat may exist All other reasonable means have been exhausted No less restrictive alternative exists

15. Suspected Terrorist Attacks N.C. Gen. Stat. § 130A-475 Definition of “public health threat”: A “situation that is likely to cause an immediate risk to human life, an immediate risk of serious physical injury or illness, or an immediate risk of serious adverse health effects.”

16. Suspected Terrorist Attacks N.C. Gen. Stat. § 130A-475 SHD has STA authority to - Require testing Test real/personal property Evacuate/close property - ten day limit; then Superior Court Limit movement/action Limit access to places

17. Suspected Terrorist Attacks N.C. Gen. Stat. § 130A-475 Many of the Communicable Disease provisions also apply to STA Orders. STA Orders are valid for ten days. “Substantially affected” person may petition (where limitations are/Wake) for review. Hearing within 72 hours (no weekends).

18. Suspected Terrorist Attacks N.C. Gen. Stat. § 130A-475 Chapter 7A – court-appointed lawyer “Substantially affected” person must show limitations are not “reasonably necessary” on review (preponderance) SHD petitions Superior Court for (30 day) extensions; for extension, SHD must show that limitations are “reasonably necessary” (preponderance)

19. Suspected Terrorist Attacks N.C. Gen. Stat. § 130A-475 Judge “shall reduce” limitations if the “substantially affected” person meets burden on review of the STA Order. Review of STA Order: Judge may apply “such conditions to the limitation as the court deems reasonable and necessary.” Make findings to support modifications anyway.

20. Violations of Communicable Disease / STA Orders N.C. Gen. Stat. § 130A-25 Violation of a quarantine / isolation / STA Order is a Class 1 misdemeanor.

21. Violations of Communicable Disease / STA Orders Section 15A-401: Defendant charged may be detained until first appearance before a judicial official. * Law enforcement may detain defendant in an area designated by SHD or LHDs until first appearance.

22. Violations of Communicable Disease / STA Orders First appearance: N.C. Gen. Stat. § 15A- 534.5 – SHD/LHDs must show by clear and convincing evidence that defendant “poses a threat to health and safety of others” for defendant to be detained.

23. Violations of Communicable Disease / STA Orders Once SHD/LHD meets burden, defendant shall be denied pretrial release and shall be confined in facility/area designated by judicial official (with input from SHD/LHD). Then: pretrial confinement until defendant is no longer a threat; burden switches to Defendant (preponderance)

24. Violations of Communicable Disease / STA Orders Section 130A-25: maximum two year sentence for violation (exempted from Structured Sentencing.) Defendant shall serve sentence in a confinement facility in consultation with SHD.

25. Violations of Communicable Disease / STA Orders Section 130A-25(c) – Defendant not to be released early (e.g., parole) until judge determines that “release will not create a danger to the public health.” Burden here appears to be on Defendant (preponderance).

26. Notes SARS in North Carolina HIPAA