1. Public Health Measures
Mary Kennedy
Deputy General Counsel
Tennessee Department of Health
September 17, 2014
It is the mission of the Tennessee Department of Health to protect, promote and improve the health and prosperity of people in Tennessee

2. What is Public Health?
“Public Health is what we, as a society, do collectively to assure the conditions in which people can be healthy.” Institute of Medicine, The Future of Public Health, 1988
Concerned with the health of the population rather than the individual.
Requires the Department to be concerned with the actions or conditions of an individual, entity or premises which may create a threat to others.

3. Tuberculosis
Eighty years ago there were over 1,000 deaths annually from TB; in 2013 Tennessee had a total of 15 deaths from TB.

4. E-Coli linked to Raw Milk
Knox County Outbreak: 9 cases, 5 hospitalized, 3 children with kidney failure; we have foodborne outbreaks annually.

5. Injectable Drug Diversion
The risk is that an injectable drug abuser with access to syringes etc., may put used syringes back where they will be re-used. The unwitting infected may then transmit a communicable disease carried by the abuser to sexual partners etc., The diseases of concern are particularly STDs and Hepatitis C

6. Ebola US Public Health Service stationed at international airports
Number of Ebola deaths in Tennessee – ZERO!

7. Authority of the Health Department
Tenn. Code Ann. Title 68
Chapter 1 – General Provisions
Tenn. Code Ann. § Commissioner, Chief Medical Officer
Tenn. Code Ann. § Rules and Regulations
Tenn. Code Ann. § Duties of Commissioner
Tenn. Code Ann. § Power to Quarantine

8. Quarantine and Isolation
Tenn. Code Ann. Title 68, Chapter 1 Part 2
Tenn. Code Ann. § Power to Quarantine
Tenn. Code Ann. § Quarantine Stations
Tenn. Code Ann. § Violation a misdemeanor

9. What’s the Distinction? Rule 1200-14-1-.01
Isolation – Separates an infected or suspect individual, or from the community during infectious period;
Quarantine – Limits freedom of movement or prevents access to the premises until diagnosis is established or confirmed in order to determine cause and prevent spread of infection
Quarantine may include isolation

10. Local Health Services Tenn.Code Ann. § 68-2-601 et seq.
Establishes County Health Department
Creates position of County health director
Creates position of County health officer
Tenn Code Ann. §
Establishes authority of County health officer to issue administrative orders and seek judicial remedies

11. Disease-Specific Chapters
Tuberculosis
Tenn. Code Ann. Title 68 Chapter 9
Sexually Transmitted diseases
Tenn. Code Ann. Title 68 Chapter 10
Both include the power of the health officer to isolate or quarantine, both specifically give jurisdiction to the General Sessions Courts

12. DISEASE CONTROL/HEALTH THREAT PROCEDURES: Rule 1200-14-4.01 et seq.
Identification of the threat;
Directive requiring cooperation with efforts to prevent disease transmission;
Petition for Temporary Hold;
Petition for Health Measure;
Issuance of Health Measure;

13. Identification of the Threat
Rule Reporting a Health Threat to Others
Any licensed health professional is required to report a person who may be a health threat to others and is acting in a manner which puts others at risk;
If a carrier who poses a threat flees the state to avoid treatment, isolation or quarantine, TDH may contact health authorities where the carrier is believed to be.
See also Rule for reporting of specific diseases to the Health Department

14. Issuance of the Health Directive
Rule Health Directive
Commissioner or Health Officer may issue directive;
Based on clinical and epidemiological findings;
Written statement, or oral statement followed in writing;
Includes findings and specific requirements to diminish the threat, using least restrictive alternative;
If subject refuses testing, presumption shifts to subject;
Subject may request review of Chief Medical Officer;
Non-Compliance is grounds for seeking health measure.

15. Temporary Hold in Emergencies
Rule
Health Officer or Commissioner may petition General Sessions Court where person may be found or premises is located for a temporary hold;
Petition is filed under seal;
Petition must include supporting affidavit;
Petition may be heard ex parte;
May order examination, isolation, treatment or, in case of premises, prevention or restriction of access;
Hold may not exceed 5 business days except by agreement, with outside limit of 15 business days;

16. Public Health Measure
Rule Petition for Public Health Measure
Commissioner or Health Officer may file petition, under seal, in General Sessions;
Must set forth grounds demonstrating threat to others;
Must propose least restrictive measure(s);
Evidentiary standard is clear and convincing;
Must give 5 business days notice and advise respondent of rights at hearing;
Respondent may appeal or seek habeas corpus, but order shall remain in force pending conclusion.

17. Commitment to Custody of the Commissioner
Rule
Must be reviewed by Chief Medical Officer at least every 92 days to determine if still appropriate;
Physical commitment must expire after 6 months unless supplemental petition is filed;
May be renewed as many times as necessary if clear and evidence that the threat to the public health continues.

18. Patient Bill of Rights Rule 1200-14-4-.08
Communication with friends, family and counsel;
Treatment shall not be forced, however refusal may compel continued action to protect the public health;
Isolation only when medically necessary;
Patient may enter into contracts, vote, execute instruments, etc.,
Patient shall be given maximum freedom possible;

19. Patient Bill of Rights (Cont’d)
Rule (Cont’d)
No mechanical restraints unless medically indicated and prescribed by physician;
All records, reports, legal documents confidential;
Health directives and public health measures should be written in plain language and include
Reasons for the action;
Tests or treatments expected;
Anticipated duration; and
Appeal Rights.