Summary of CDC’s Approach to Characterizing States’ Laws for Quarantine Expert Panel on Isolation and Quarantine University of Michigan School of Public Health June 2-3, 2009 Richard A. Goodman, MD, JD, MPH Public Health Law Program Centers for Disease Control and Prevention

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Public Health Legal Preparedness Effective laws Competencies to apply laws Coordination in application of laws across sectors and jurisdictions Information on best practices on relevant laws

Assessments of Legal Authorities and Best Practices for Quarantine, Isolation, and Related Measures Suite of CDC studies University of Michigan development of best practices Public Health Seattle & King County and NACCHO national survey City of Milwaukee and NACCHO project New England Public Health Law Project on isolation of infectious TB patients

CDC’s Characterization of States’ Quarantine Laws: Spectrum of Complexity of Approaches Simplest: 2003 rapid telephonic assessment of all 50 states regarding each state’s self-determination of sufficient legal authority to support quarantine needs during SARS Intermediate: Qualitative review of express quarantine / related laws to restrict movement of persons in 10 most populous U.S. states, with sharing of preliminary results with states’ public health counsel for review and comment More complex: CDC / ASTHO Social Distancing Law Project (SDLP) combining legal assessment by jurisdiction’s counsel (n=17) with follow on TTX scenario within jurisdiction (n=11) Most complex: In-progress SDLP coupled with jurisdictions’ use of “guide to developing MOU for multi-sector response” and / or Forensic Epidemiology scenario on coordinated public health and law enforcement response to pandemic influenza

CDC’s Characterization of States’ Quarantine Laws: Related Approaches Involving Social Distancing Commissioned study of states’ legal authorities for dismissing schools Studies of and best practices for law in the prevention / control of TB –Commissioned study of states’ express laws on prevention and control (including quarantine and isolation measures) –Study of Tribal code on TB control –Table-top scenario for states’ assessment of understanding and sufficiency of TB control law

CDC 10-State Study of Quarantine Laws March – Dec. 2004: Conducted detailed qualitative review of express state laws for quarantine, isolation, and other powers limiting the movement of persons Studied 10 most populous states (US Census 2000): CA, FL, GA, IL, MI, NJ, NY, OH, PA, TX Some state counsel consulted during study Preliminary findings circulated to state counsel for review and comment

CDC 10-State Study of Quarantine Laws Terminology varies greatly among states: e.g., laws may refer to isolation, quarantine, commitment, control of person, detention, exclusion, holding, removal, restriction, segregation, travel restriction, or other unspecified restriction All jurisdictions have authority to separate or detain Some authorities (example: area quarantine) only available during declared emergencies Examples of other key variations by state: –Needs for a court action to initiate quarantine –Variations in scope of authority as function of whether emergency declared –Variations in due process requirements

CDC 10-State Study of Quarantine Laws Laws are often weakly organized, overlapping, excessively complex, and difficult to read, understand, and interpret Nature and scope of laws vary tremendously from state to state Adequacy difficult to assess in absence of court challenges, which are rare (little case law)

Characterizing States’ Quarantine Laws: General Summary Points States appear to have adequate legal authority for implementing / enforcing quarantine and isolation Areas of concern: –Locus of authority to order / enforce –Coordination across jurisdictions and sectors –Lack of experience in implementing

Characterizing States’ Quarantine Laws: Lessons Learned 1.Must work with jurisdiction’s legal counsel to ensure all relevant law ascertained, and because of respective jurisdiction’s / counsel’s paramount interests in how the jurisdiction’s laws may be reported on in public venues 2.Substantial time and labor obligations to conduct complete identification and verification of applicable law 3.Maximal determination of status, understanding, and potential sufficiency of law is obtained when review of law is combined with testing (e.g., SDLP, including review of law and legal consultation meeting with TTX)

Guide to Developing and MOU for Coordinated Implementation of Community Response Measures Scope: –Covers the set of community measures that would occur when a contagious disease (e.g., virulent influenza) already has reached pandemic status. At this point, some measures (e.g., involuntary quarantine and isolation) would have limited, if any, indication because of the substantial spread of the disease in question. Instead, public health officials and counterparts in other sectors will be relying on other measures that limit contact between people, (e.g., encouraging people to stay home from work and school and banning congregating in groups).

For Additional Information on Public Health Law All accessible at Compilation of public health legal preparedness resources National Action Agenda for Public Health Legal Preparedness “Public Health Law 101” and “Public Health Emergency Law” Courses CDC Public Health Law News