Comparison of Health Laws Audrey Kaiser Manka, J.D. Minnesota Assistant Attorney General "The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.”

Health Laws Compared in this Talk Health Threat Procedures Act §§ Tuberculosis Health Threat Act §§ Isolation and Quarantine Statute §§

Noncompliant Carrier Minn. Stat. §§ Noncompliant TB Carrier Minn. Stat. §§ Emergency Powers Minn. Stat. §§ IsolationQuarantine Covered Individuals Individual Individual or Group Covered Individuals

Noncompliant Carrier Minn. Stat. §§ Noncompliant TB Carrier Minn. Stat. §§ Emergency Powers Minn. Stat. §§ IsolationQuarantine Disease or Condition 1.Directly transmitted -sexually transmitted - blood borne; or -direct or intimate skin contact 2.Indirectly transmitted (any other transmission) Tuberculosis (includes both infectious and non- infectious Tuberculosis) Infected by new, novel, or previously controlled communicable disease or bioterrorism. Likely to have been exposed to new, novel, or previously controlled communicable disease or bioterrorism. Does not include directly transmitted diseases, i.e. STDs Disease or Condition

Noncompliant Carrier Minn. Stat. §§ Noncompliant TB Carrier Minn. Stat. §§ Emergency Powers Minn. Stat. §§ IsolationQuarantine NoticeHealth Directive, personally served in same manner as summons and complaint Health Order, personally served by peace officer or disease prevention officer Individual orders, or, if impracticable, group posting in conspicuous place. If posting is impractical, the Court must use the best means available. Notice rather than service. Notice

Noncompliant Carrier Minn. Stat. §§ Noncompliant TB Carrier Minn. Stat. §§ Emergency Powers Minn. Stat. §§ IsolationQuarantine DesignationHealth threat to others - Carrier demonstrates an inability or unwillingness to act in such a manner as to not place others at risk of exposure to infection that causes serious disease, serious disability, or death. i.e. repeated behavior that has been demonstrated epidemiologically to transmit the disease. Endangerment to public health. -Carrier may transmit the disease to others by certain conduct: i.e. - fails or refuses to submit to examination - misses 20% of appointments for DOT or two consecutive appointments - fails or refuses to complete treatment - fails or refuses to keep treatment appointments. Infected and isolation is an effective control strategy. Likely to have been exposed and quarantine is an effective control strategy. Designation

Noncompliant Carrier Minn. Stat. §§ Noncompliant TB Carrier Minn. Stat. §§ Emergency Powers Minn. Stat. §§ IsolationQuarantine Burden of Proof - Reasonable cause for issuance of apprehend and hold order or temporary emergency hold -Clear and convincing at court hearing -Probable cause to issue health order - Preponderance of evidence at preliminary hearing - Clear and convincing evidence at final hearing -Standard for temporary hold: delay in I/Q would significantly jeopardize MDH’s ability to limit or prevent transmission - Probable cause to believe I/Q is warranted at ex parte hearing - Clear and convincing evidence at court hearing Burden of Proof

Noncompliant Carrier Minn. Stat. §§ Noncompliant TB Carrier Minn. Stat. §§ Emergency Powers Minn. Stat. §§ IsolationQuarantine Enforce- ment Action Health Directive ↓ Petition to Enforce or Temporary Emergency Hold to protect the public health (72 hours) - either apprehend and hold, if at large, or - order health facility to hold Health Order ↓ Notice of Obligation to Isolate or Examine (72 hour hold which may be extended by ex parte order for up to 6 days) or Apprehend and Hold ↓ Preliminary hearing ↓ Final hearing (periodic review every 90 days) Temporary hold upon Commissioner’s Directive (lasts up to 48 hours; petition must be filed with the court within 24 hours, then the court must rule within 24 hours after receiving petition) or Ex parte Court Order (lasts up to 21 days) ↓ Unless Court hearing requested (to be held within 72 hours and may extend I/Q for 30 days) ↓ Hearing on Conditions of Isolation or Quarantine ↓ Released immediately when Commissioner determines no further need for isolation/ quarantine, or automatically upon expiration of court order Enforcement Action

Noncompliant Carrier Minn. Stat. §§ Noncompliant TB Carrier Minn. Stat. §§ Emergency Powers Minn. Stat. §§ IsolationQuarantine Location of Hearing County where carrier resides County where carrier resides; May be in a hearing room in treatment facility or court may designate another location County where person is located or in an adjoining county, or Ramsey County (statewide jurisdiction) Location of Hearing

Noncompliant Carrier Minn. Stat. §§ Noncompliant TB Carrier Minn. Stat. §§ Emergency Powers Minn. Stat. §§ IsolationQuarantine Right to and Duties of Counsel Recognizes right to counsel, including, if indigent, the right to court designated counsel. Counsel shall: - consult with person prior to hearing - be given adequate time to prepare - continue representation until released by court - be a vigorous advocate Court appointed. Commissioner to provide certified copies of relevant medical records Duty to communicate: - statement of disputed facts - names and addresses of witnesses and summary of testimony Recognizes right to counsel, including, if indigent, the right to court designated counsel. Right to and Duties of Counsel

Noncompliant Carrier Minn. Stat. §§ Noncompliant TB Carrier Minn. Stat. §§ Emergency Powers Minn. Stat. §§ IsolationQuarantine Court Ordered Measures - Education - Counseling - Treatment - Medical tests - Monitoring - Cease and desist - Supervised living - Isolate and detain for treatment - Examination - Remain in treatment facility to complete course of treatment - Exclude carrier from work or school as necessary - Provide necessary medical and epidemiological data - Testing of others in carrier’s household, workplace or school - Follow contagion precautions - Isolation - Quarantine Court Ordered Measures

Noncompliant Carrier Minn. Stat. §§ Noncompliant TB Carrier Minn. Stat. §§ Emergency Powers Minn. Stat. §§ IsolationQuarantine Appeal Rights Court of Appeals shall hear appeal within 30 days Court of Appeals shall hear appeal within 60 days As per Minn. R. of Civ. Appellate Procedure Appeal Rights