Isolation and Quarantine and Emergency Laws in Ebola Virus Cases Commonwealth of Virginia Office of the Attorney General March 2015

Governor’s Authority Commonwealth of Virginia Emergency Services and Disaster Law of Commonwealth of Virginia Emergency Services and Disaster Law of Va. Code § et seq.

Governor’s Authority Declare state of emergency. Declare state of emergency. Issue executive orders and proclaim rules for purposes of emergency. Issue executive orders and proclaim rules for purposes of emergency. Implement Emergency Operations Plan Implement Emergency Operations Plan Direct and compel evacuation of all or part of the populace from any stricken or threatened area Direct and compel evacuation of all or part of the populace from any stricken or threatened area Mobilize emergency management organizations Mobilize emergency management organizations Enter mutual aid arrangements Enter mutual aid arrangements Control ingress and egress at emergency area, including movement of persons and occupancy of premises. Prescribe routes, modes of transportation, and destination Control ingress and egress at emergency area, including movement of persons and occupancy of premises. Prescribe routes, modes of transportation, and destination Va. Code §

Local Government Authority When Governor declares a state of emergency, each political subdivision within the disaster area may, under the supervision of the Governor: When Governor declares a state of emergency, each political subdivision within the disaster area may, under the supervision of the Governor: – Control use, sale, production, and distribution of food, fuel, clothing, materials, goods, services, and resource systems that do not impact other political subdivisions. – Enter into contracts and incur obligations without usual formalities. – Protect the health and safety of persons and property. – Provide emergency assistance to victims. Va. Code §

Local Government Authority When locality declares an emergency, it may: When locality declares an emergency, it may: – Control use, sale, production, and distribution of food, fuel, clothing, materials, goods, services, and resource systems that do not impact other political subdivisions. – Enter into contracts and incur obligations without usual formalities. – Protect the health and safety of persons and property. – Provide emergency assistance to victims – If Governor has declared state of emergency, may w/ supervision act outside capabilities of local govt. Va. Code §

Federal Authority 42 U.S.C. § 264; 42 C.F.R. Parts 70 and 71 – Government may detain those coming in from a foreign country – Government may detain those making interstate travel if: Communicable Pre-communicable if would cause a public health emergency if transmitted

State Authority Orders not necessary when person voluntarily complies with public health recommendations. Orders issued when voluntary compliance fails or exceptional circumstances exist Isolation orders Quarantine orders

Isolation Separation (for period of communicability) of known/suspected infected persons to prevent transmission of an infectious agent

Quarantine Separation of well persons who have been exposed to a communicable disease and who may therefore be infectious, to prevent transmission to others if they get sick

Conditions for Issuing Order of Isolation or Quarantine Commissioner (only) may invoke Code of Virginia § et seq, to isolate or quarantine an individual if: 1.They are known/suspected to have been infected with or exposed to a communicable disease of public health threat, and 2.Exceptional circumstances exist such that extra disease control measures are necessary, or the individual has failed or refused to comply voluntarily with control measures, and 3.Isolation/quarantine is the necessary means to contain the threat

Illness of Public Health Importance Communicable Disease of Public Health Significance Communicable Disease of Public Health Threat Illness/Disease

Communicable Disease of Public Health Threat  Communicable disease of public health significance that is readily transmitted and creates a risk of death or significant injury (not including TB or HIV)  Examples: – Viral hemorrhagic fever (e.g., Ebola) – Smallpox – Pneumonic plague – Pandemic influenza

Exceptional Circumstances – Factors (as determined by Commissioner) that affect ability to effectively control a communicable disease – Include: Organism (virulence, transmission, infectious dose, rapidity of spread) Potential for extensive disease spread Existence and availability of effective treatment Known or suspected risk factors Potential magnitude of the effect on welfare of the public Extent of voluntary compliance

Isolation or Quarantine Order will include: The disease of public health threat The exceptional circumstances The means by which quarantine or isolation is implemented (the place) The duration of the order The penalties for noncompliance Appeal rights

Additional Requirements 1.Least restrictive environment necessary to contain threat 2.Quarantined persons confined separately from isolated persons, as practicable 3.Regular monitoring of the health status 4.If quarantined person symptomatic, remove from quarantine and place in isolation 5.Immediate release if person poses no risk of transmitting 6.Site must be safely and hygienically maintained with adequate food, clothing, health care, and other essential needs met

Procedure for Issuing the Order State Health Commissioner issues the Order of Isolation or Quarantine. Order is delivered to the person by law enforcement, a state or local health department employee, or their designees. VDH (through the AG’s Office) files a petition seeking ex parte review and confirmation of the order in circuit court. Appeal, if any.

Health and Safety The Court shall hold hearings in a way to protect health and safety The Court shall hold hearings in a way to protect health and safety – Hearing by telephone or video conference – Personal protective equipment Electronic filing Electronic filing Rules 3.24, 5:41, 7A:16; Va. Code § :1

Released from the Order when: Time specified in the Order has expired; or Released by the Commissioner if determined no longer a threat to public health; or Ordered by the court.

Potential Roles for Law Enforcement Help enforce compliance with an order Help locate someone who has left the quarantine/isolation location and entered the general community Ensure the safety of the home or other location where a person is being confined for quarantine/isolation purposes

Enforcement of the Order Law enforcement may use electronic monitoring. Law enforcement can detain or arrest a person who violates the order or if probable cause exists that the person will not comply.

Penalties for Noncompliance with Order Va. Code § provides that any person willfully violating or refusing, failing or neglecting to comply with any regulation or order of the Board or Commissioner shall be subject to: – A Class 1 Misdemeanor, upon conviction. – Injunctive relief (a court order requiring compliance with the Order). – Civil penalties not to exceed $25,000.

Applicable Code Sections Isolation and Quarantine: – Va. Code § to – 12 VAC et seq. For LE Officers: – Va. Code § (A) “Any person who does not comply with a validly issued order of quarantine or order of isolation issued or prepared pursuant to this article shall be subject to the penalties provided in § , including, upon conviction, a Class 1 misdemeanor and payment of civil penalties”

Applicable Code Sections For LE Officers: – Va. Code § (B) “Any order of quarantine or isolation shall be enforced by law-enforcement agencies, as directed by the State Health Commissioner. Any enforcement authority... shall expressly include, but need not be limited to, the power to detain or arrest any person or persons identified as in violation of any order of quarantine or isolation, or for whom probable cause exists that he may fail or refuse to comply with any such order. ”

Applicable Code Sections For LE Officers: – Va. Code § (B) “Any person or persons so detained shall be held in the least restrictive environment...” – Va. Code § (C) “Every attorney for the Commonwealth shall have the duty to prosecute, without delay, any violation of this chapter in accordance with the penalties set forth in § ”

Public Health Responsibilities Assess the situation and gather info for record of findings – share with VDH state office for preparation of orders Identify a place of isolation/quarantine and least restrictive means that effectively protects unexposed and susceptible individuals Coordinate with local law enforcement to ensure delivery of order(s) by an appropriate party, in person to the extent practicable

Public Health Responsibilities Ensure that law-enforcement personnel responsible for enforcing orders are informed of measures to take to protect themselves Monitor the health of those under an order (e.g., regular telephone calls, visits, self-reports, report of caregivers or healthcare providers, etc.) and compliance with order With local emergency management resources and community organizations, ensure individual essential needs are met to the extent practicable Ensure coordination and communication at all levels

Key Points If there is concern about EVD, ask about travel history within last 21 days to an Ebola-affected area No risk of EVD for those in the U.S. 21 days or longer and no exposure to an ill person in the U.S. with EVD People free of EVD symptoms cannot spread the disease The health department should know quickly if someone who has been in an affected country develops symptoms of EVD Laws are in place that authorize actions to protect public health