An Introduction to Public Health Law in Texas

1. An Introduction to Public Health Law in Texas Anne Kimbol University of Houston Health Law and Policy Institute

2. What is Public Health Law? • Intersection between public health professionals and government/regulation • Largely deals with authority and the balance between the need to protect the public health and individuals’ rights

3. Authority in Texas - Federal • Police powers v. Commerce Clause. • President – communicable disease definition • Secretary of HHS/CDC – regulations relating to communicable diseases and help states

4. Authority in Texas - Governor • Texas Disaster Act • Evacuations • Emergency management plan

5. Authority in Texas - DSHS • Implementation of communicable disease control measures • Declare public health disaster • Define reportable diseases • Help/preempt local authorities • Investigate cases

6. Authority in Texas - Local • Local health authority is in charge of control measures locally and most communication between locals and DSHS • Authority generally overlaps with DSHS but with area limitations • For certain actions, LHA must consult DSHS

7. Authority in Texas - Courts • Courts largely play a role of ensuring adequate balance between public safety and individual rights • Mostly get involved when a party refuses to comply with an order from the LHA or DSHS

8. Reportable Diseases - Who? • Dentists • Vets • Local school authorities • Person in charge of clinical or hospital lab, blood bank, mobile unit, or other facility performing labs • RN • Administrator or director of nursing home, personal care home, maternity home, adult respite care center, adult day-care center, home health agency, institution of higher ed, public or private camp, home, or institution, correctional institution • Owner or manager of restaurant, dairy, other good handling or processing place • EMT • Peace officer • Firefighter

9. Defined by DSHS http://www.dshs.state.tx.us/idcu/investigation/conditions/ Additional organisms Information to be reported Reportable Disease – What And When?

10. Reportable Diseases - Animals • Multiple species diseases • Akabane - Akabane virus • Anthrax** - Bacillus anthracis • Aujeszky’s disease - Pseudorabies virus, herpesvirus suis • Leishmaniasis** - Leishmania infantum and L donavani • Foot and mouth disease - Aphthovirus, types A,O,C, SAT, Asia • Heartworm - Cowdria ruminantium • African Trypanosomosis (Nagana) - Trypanosoma brucei, T. vivax, • T. brucei • Rinderpest - Morbillivirus • Rift Valley fever - Bunya virus • Vesicular stomatitis - Rhabdovirus; 2 serotypes; New Jersey and Indiana • Screwworm - Cochliomyia hominivorax • Cattle diseases (including Exotic Bovidae) • Bovine babesiosis - B. bovis, B. divergens, Babesia microti • Bovine brucellosis - Brucella abortus • Bovine ephemeral fever - Rhabdovirus • Bovine tuberculosis - Mycobacterium bovis • East coast fever (Theileriosis) - Theileria parva • Malignant catarrhal fever (wildebeest associated) – Alcelaphine herpesvirus (AHV 1) • Contagious bovine pleuropneumonia - Mycoplasma mycoides • Lumpy skin disease - Neethling poxvirus • Bovine spongiform encephalopathy - • Scabies - Sarcoptes scabiei, Psoroptes bovis, Chorioptes bovis

11. Reportable Diseases - Animals • Cervidae • Brucellosis - Brucella abortus, Brucella suis (biotype 4) • Chronic Wasting Disease - • Tuberculosis - Mycobacterium bovis • Sheep and goat diseases • Caprine and ovine brucellosis (not B. ovis infection) - Brucella melitensis • Contagious caprine pleuropneumonia - Mycoplasma capri (biotype 78) • Louping ill - Flavovirus • Nairobi sheep disease - Bunyaviridae • Peste des petits ruminants - Morbillivirus, Paramyxoviridae family • Sheep pox and goat pox - Capripoxvirus • Scrapie • Scabies - Sarcoptes scabiei • Equine diseases • African horse sickness - Orbivirus • Contagious equine metritis - Tayorella equigenitalis • Dourine - Trypanosoma equiperdum • Epizootic lymphangitis - Histoplasma farciminosum • Equine encephalomyelitis (Eastern and Western)** - Alphavirus • Equine infectious anemia - Lentivirus • Equine morbillivirus pneumonia - Morbillivirus • Equine piroplasmosis - Babesia equi, B. caballi • Glanders - Pseudomonas mallei • Japanese encephalitis - Flavovirus • Surra - Trypanosoma evansi • Venezuelan equine encephalomyelitis** - Alphavirus; Togaviridae family • Equine Viral Arteritis (EVA)* *** • Equine Herpes Virus-1 (EHV-1)*

12. Reportable Diseases - Animals • Swine diseases • African swine fever - Poxvirus • Classical swine fever (hog cholera) - Togovirus • Pseudorabies - Herpesvirus suis • Porcine brucellosis - Brucella suis • Swine vesicular disease - Picornavirus • Vesicular Exanthema - Calicivirus • Poultry diseases • Avian influenza - Orthomyxoviruse • Avian infectious laryngotracheitis - Orthomyxovirus, herpesvirus • Avian tuberculosis - Mycobacterium avium serovars 1,2 • Duck virus hepatitis - Picornavirus • Duck virus enteritis  - Herpesvirus • Fowl typhoid - Salmonella gallinarum • Highly pathogenic avian influenza (fowl plague) - Orthomyxovirus (type H5 or H7) • Infectious encephalomyelitis - Arbovirus • Ornithosis (psitticosis) - Chlamydia psittaci • Pullorum disease - Salmonella pullorum • Newcastle disease (VVND) - Paramyxovirus-1 (PMV-1) • Paramyxovirus infections (other than Newcastle disease) - PMV-2 to PMV-9 • Rabbit diseases • Myxomatosis - Myxomatosis virus • Viral haemorrhagic disease of rabbits - Calciviral disease • *These diseases will only be reportable through the last day of the 81st Texas Legislative Session unless continued in effect by act of the legislature. • **These diseases are also reportable to the Department of State Health Services (DSHS) • ***This disease has reporting standards in Chapter 49, §49.4 of this title (relating to Equine Viral Arteritis (EVA): Reporting and Handling for Breeding of Infected Equine).

13. Reportable Diseases – Where? • To DSHS or Local Health Authority • Local Health Authority must report to DSHS • Texas Animal Health Commission

14. Reportable Diseases – Why? • Tracking • Class B Misdemeanor • Liability protection for good faith reporting • Protection of those handling dead bodies

15. Communicable Diseases - Schools • LHA may close school if needed to protect public health • Exclusionary conditions • Amebiasis • Campylobacteriosis • Chickenpox Amebiasis • Common cold • Conjunctivitis, bacterial and/or viral • Fever • Fifth disease • Gastroenteritis • Giardiasis • Head lice • Hepatitis A • Impetigo • Infections mononucleosis • Influenza • Measles • Meningitis bacterial • Mumps • Whopping cough • Ringworm • Rubella • Salmonellosis • Scabies • Shigellosis • Streptococcal sore throat and scarlet fever • – until antibiotic treatment has begun and physician certificate or health permit is obtained

16. Quarantine and Isolation - Terms • Quarantine • Not defined in Texas H&S Code • PH definition – Separation and restriction of movement of individuals who are not yet ill but have been exposed to a communicable disease • Isolation • Also not defined in law • Separation of individuals ill with a communicable disease • Terms are often used interchangeably in law

17. Quarantine and Isolation - Property

18. Q&I – Property - DSHS • Right of entry • Samples • Impose control measures • Quarantine • Restrict access • Destruction

19. Q&I – Property – LHA • Same as DSHS within region

20. Q&I – Property – Courts • Penalties • Enforcement

21. Quarantine and Isolation - Carriers

22. Q&I – Carriers - DSHS • Order the vehicle stopped • Get information on people aboard • Impose control measures

23. Q&I – Carriers – LHA • Same as DSHS

24. Q&I – Carriers - Courts • Penalties • Enforcement

25. Quarantine and Isolation - Areas

26. Q&I – Areas – DSHS • Quarantine • Investigations • Work with neighboring states • Publish notice • Obtain immunization records

27. Q&I – Areas – LHA • Quarantine after DSHS consult • Written notice • Governing body • Public • Designate facilities

28. Q&I – Area – Courts • Penalties • Enforcement • Suspend admission of patients seeking elective treatment

29. Quarantine and Isolation - People

30. Quarantine and Isolation - People

31. Q&I – People – DSHS • Preempt LHA • Return other states’ residents • Impose control measures • Individuals • Groups

32. Q&I – People – LHA • Same as DSHS

33. Q&I – People – Courts • Penalties • Different types/levels/procedures for enforcement • Order for Management of Person with a Communicable Disease • Temporary • Extended • Protective Custody Orders

34. Q&I – People – Courts – PCO • Motion for Order for temporary protective custody • Order for TPC • Motion for Order for Protective Custody • Attorney • Probable Cause hearing • Court order – continued detention or release

35. Q&I – People – Courts – OMPCD • Application • Appointment of attorney • Timing • Notice • Recommendations • Hearing • Court decision – release, outpatient, temporary, extended

36. Q&I – People – Modifications • Cause • Notice • Hearing • Detention • Counsel • Court decision

37. Q&I – People – Renewal • For extended management order • Application • Affidavit • Attorney • Hearing

38. Q&I – People – Rehearings • Rehearing • Appeal • Examination • Timing

39. Q&I – People – Treatment • Facility • Temporary Passes • Release/discharge

40. Q&I – People – Groups • Any statement or determination regarding the conduct of a member of the group must apply to the majority of its members; • Any finding or statement regarding compliance must apply to all members of the group; • Any notice being sent to the group must also be published in the local newspaper of general circulation, state that the group is appointed one attorney but any individual member may request an individual attorney, and include instructions for people who suspect they may be part of the group to contact DSHS or the LHA.

41. Rabies • A reportable condition in humans and animals • For animals • Report within one working day of diagnosis for animal • Report to regional zoonosis control office of Zoonosis Control Division in Austin • For humans – report immediately to LHA or DSHS regional director (considered public health emergency)

42. Rabies – DSHS • H&S Code Chapter 826 • Set minimum standards • Provide vaccine or serum • Adopt control measure rules • Hold hearings • Regulate facilities • Override locals

43. Rabies – Local/Professionals • Local rabies control authority • Animal licensing • Quarantine and other control measures • Liability protection for veterinarians • Exemptions for police dogs • Penalties for facilities • Rabies biologicals

44. Rabies – Individuals • Vaccinate cats and dogs • Penalties for failure • Reporting of suspected rabies and/or possible transmission to humans

45. Rabies – Area Quarantines • Area quarantine if rabies exists in an area • Borders and rules adopted • Restraint provisions • Penalty for failure to comply

46. Contact Information; Other • UH Health Law and Policy Institute will be releasing a bench book for judges on isolation and quarantine issues. Will include charts shown here as well as sample forms and simplified language summarizing the key statutes. • Anne Kimbol, askimbol@central.uh.edu, 713-743-2198

47. Further Contacts/Information • FEDERAL • Centers for Disease Control and Prevention (800) CDC-INFO • Federal Emergency Management Agency (800) 621-FEMA • National Institutes of Health (301) 496-4000 • Office of the Surgeon General (301) 443-4000 • Public Health Service Commissioned Corps (240) 453-6000 • STATE • Commissioner of Health (888) 963-7111 • Governor’s Office (800) 843-5789 • Office of General Counsel, TDSHS (512) 458-7236 • Office of Public Health Practice, TDSHS (512) 458-7700 • Center for Public Health Preparedness and Response, TDSHS (512) 458-7219

48. Further Contacts/Information • SUGGESTED LOCAL CONTACTS • County Commissioners’ Court • County and/or municipal departments of health • City Council • City Attorney’s Office • Local office of public health preparedness • County Attorney • County Appraisal District • Information Available on the Internet • Centers for Disease Control and Prevention http://www.cdc.gov/ • Federal Emergency Management Agency http://www.fema.gov/ • National Institutes of Health http://www.nih.gov/ • Governor’s Office http:///www.governor.state.tx.us • Texas Department of State Health Services http://www.dshs.state.tx.us • Communicable Disease Control Measures in Texas, DSHS Report http://www.dshs.state.tx.us/comprep/ogc/cdmanual.pdf • Avian Flu Pandemic Litigation Forms, Office of the Attorney General http://www.oag.state.tx.us/notice/emergency /birdflu/index_forms.php