Best Practices in Isolation and Quarantine

1. Best Practices in Isolation and Quarantine Results of a National Survey of State Epidemiologists Part I: Legal Basis for Isolation and Quarantine

2. Have you consulted with a legal adviser to answer the questions in Part I?

3. Do your state isolation and quarantine laws exist as statutes (written laws passed by legislature) or as regulations (administrative rules with the force of law promulgated and enforced by government agencies)?

4. When were the state's isolation and quarantine laws last revised?

5. Where do the laws and statutes related to isolation and quarantine reside? Other: CT General Statutes, Ohio Revised Code Chapters 3701, 3707 and 339 (TB), KSA 65-128, 65-129ato 65-129e, KAR 28-1-5 and KAR 28-1-6 ; state statutes and 173NAC6; Health and Safety Code; Massachusetts General Laws; SDCL 34-22 & ARSD 44:20

6. Does the code specify a length of time that state and local public health officials can detain an individual or groups of persons for quarantine or isolation? If so, please specify length of time. Yes: depends on agent/situation; not to exceed the period of incubation and communicability; as long as needed; until disease has been rendered noncommunicable; minimum necessary to accomplish public health objective; 36 hrs- if court order is granted can detain until no longer contagious; 72 hrs; not more than 20 days; 30 days (4); 180 days; 6 months (2)

7. Does the state law provide for due process for individuals and groups (i.e. procedural protections requiring a judicial hearing either before or after quarantine is imposed)?

8. Have the state and local health departments promulgated regulations to implement due process when isolation and quarantine are ordered?

9. Does the state code differentiate isolation and quarantine procedures and response based on the number of persons affected (e.g. individual vs. groups of persons)?

10. Do the legal criteria for differentiating procedures and response based on number of persons affected reside in statutes or regulations?

11. Which of the following persons have independent legal decision-making authority to declare an emergency for epidemics or other communicable disease threats and/or implement isolation and quarantine of INDIVIDUALS or GROUPS OF PERSONS? (Check all that apply) Other: Municipal and county governments; physician designated by State Health Officer; county or city chief executive official; State Medical Officer; local health officer for groups only with permission of State Health Officer; Dept of Health and Environment; on-call physicians and other disease control staff with delegated authority; Local Board of Supervisors or designee; Deputy Secretary of Health Planning and Assessment

12. Has the person(s) with legal authority to order quarantine and/or isolation provided written formal guidance to state and local public health officials on how to proceed with implementation of quarantine/isolation?

13. Who has the state public health agency identified to serve as "legal adviser" to provide interpretation of quarantine and isolation authority? (Check all that apply) Other: State public health agency staff attorneys; Assistant Legal Counsel- Health Department; Assistant Attorney General; County attorneys; Cabinet for Health Family Services Legal Counsel; Staff Attorney, Public Health Preparedness and Emergency Response; Local Health Officer’s Counsel; Bureau for Public Health Legal Counsel; Health Department Deputy Counsel

14. Has the legal adviser issued formal guidance on how to meet individual and group due process requirements?

15. Does the State Health Officer have express authority to order isolation and quarantine in the absence of a declared emergency?

16. In the event of a legal challenge to an isolation or quarantine order authorized by the local public health agency, who has authority to override the order? (Check all that apply) Other: Judges/Courts (12) ; local board of health; state board of health Comments: Only the State Health Department has authority to establish quarantine or isolation; orders by local agencies are coordinated with state health officer; locals can’t order isolation or quarantine (2); not specified in statute or rule

17. From your state's perspective, does the CDC or other federal entity have the legal authority to mandate individual or group isolation or quarantine?

18. If CDC or another federal entity mandates individual or group isolation or quarantine in your state, which governmental entity bears the attendant costs? (Check all that apply) Comments: CDC has authority at international border, our attorney is not aware of in-state authority (3); federal government should fund federal order but since a formal statement has not been made, we are assuming state funds may be necessary; determined jointly on a case-by-case basis; CDC can only order isolation and quarantine when federal declaration of emergency has been issued; not specified by law, rule or policy; don’t know

19. Does the state public health agency have memoranda of understanding (MOU) on isolation and quarantine with any of the following? (Check all that apply) Comments: All local health departments are in the state system; we have MOUs with some facilities for use for emergency response purposes but not specifically iso/quar; not required- our statutes grant that authority only to the state; public health agency has taken education and informational, rather than legalistic approach, to outreach to government and private sector partners

20. Do isolation and quarantine laws in your state mandate MOUs with law enforcement or Emergency Medical Services?

21. Does state law mandate/provide for the following quarantine/isolation (Q&I) procedures? If YES, identify whether the law exists as a STATUTE, REGULATION, or BOTH. If NO, choose NO LEGAL MANDATE.

22. Please describe any deficiencies in the legal authority in ordering or enforcing isolation/quarantine as identified by the state public health agency or state Attorney General. We need to better define due process for group quarantine or isolation. Where there is concurrent authority we need MOUs specifying how each entity will carry out its authority The lack of express due process rights within the quarantine and isolation statutes is currently being addresses by state legislation No appeal from a local Q&I order; no administrative procedure Need "exercises” Training local judges on isolation/quarantine laws to avoid delays or gaps in an emergency Chemical, radiologic, and nuclear events Although Massachusetts has adequate legal authority, the statutes are archaic. Pending legislation would update and modernize law regarding I&Q

23. Please describe any deficiencies in the legal authority in ordering or enforcing isolation/quarantine as identified by the state public health agency or state Attorney General. (Continued) Not a deficiency but a comment. Our statues do not identify "groups" as a unit for I&Q. Legal department interpretation is that we still need to serve orders that identify each person as an individual Need better statutory clarification on groups-no provision for income replacement The statute provides for the appointment of counsel to represent individuals who are about to be quarantined. The provision should be further clarified Habeas corpus statute (KSA 60-1505) currently requires the district court judge to appoint at least two competent physicians to examine persons under isolation or quarantine and report their findings to the judge. We have introduced a bill in the current legislative session to strike this language from the statute.

24. Best Practices in Isolation and Quarantine Results of a National Survey of State Epidemiologists Part II: Isolation and Quarantine Policies and Practice

25. Please indicate the number of times in the last 5 years that your state has invoked isolation or quarantine policies for INDIVIDUALS or GROUPS.

26. Has state-ordered isolation or quarantine been an effective disease control tool in your state in the last 5 years?

27. In practice, who is responsible for declaring an emergency for epidemics or other communicable disease threats and/or implementing isolation and quarantine of INDIVIDUALS and GROUPS OF PERSONS? (Check all that apply) Other designees: A State Medical Officer, Local executive officer (emergency declarations), State disease control program, State public health director, secretary of the department of health, Deputy/Assistant State Health Officer, Chief presiding officer of the local government, Local Boards of Supervisors, Deputy Secretary for Health Planning and Assessment, Mayor

28. Who is primarily responsible for advising the state health officer on whether to implement isolation and quarantine? (Check all that apply) Other: General Counsel, Regional Directors, Assistant State Epidemiologist, Disease Control Program Staff, Local Health Officers, Director of the Office of Public Health, Deputy Commissioner, Division of Acute Epidemiology, Deputy Secretary for Health Planning and Assessment

29. In your state public health agency, which department/office has primary responsibility for handling logistics for GROUP isolation and quarantine? Other: Bureau of Health Emergency Preparedness, Local responsibility, multiple agencies at state level, shared between Public Health Preparedness and Communicable Disease Comments: No plans for group isolation/quarantine; emergency support functions as defined in the state plan

30. Which organizational entities have responsibility for ensuring each of the following components of isolation and quarantine? (Check all that apply)

31. Are there provisions made in the state public health agency's plan (including delegation of responsibility to local public health) for each of the following when ordering AT-HOME isolation or quarantine?

32. Are there provisions made in the state public health agency's plan (including delegation of responsibility to local public health) for each of the following when ordering INSTITUTIONAL (hospital) isolation or quarantine?

33. Which of the following has primary responsibility for covering associated costs for INSURED and UNINSURED patients in the event of state-ordered isolation and quarantine in a healthcare facility? (Check all that apply)

34. Does the state ever order isolation and quarantine without engaging the affected local public health agencies in the decision-making process?

35. Which of the following organizations has the state public health agency engaged to coordinate roles and responsibilities dealing with isolation and quarantine? (Check all that apply) Other: State Department of Homeland Security, Red Cross, hospitals, Attorney General, Circuit Courts, Regional Public Health Emergency Planning Teams, Department of Education, legal associations, private healthcare, military, behavioral health, Department of Corrections, Emergency Management Comments: All local health departments are part of the state system; Isolation/quarantine have been a local responsibility

36. When were the state's isolation and quarantine laws/statutes last reviewed by state public health officials?

37. Please rate the level of importance of each of the following concerns in impacting decisions to ORDER and TERMINATE isolation or quarantine using the following scale: 1=not important 2=of little importance 3=moderately important 4=important 5=very important

38. Which criteria determine whether isolation/quarantine for an emergency event can be ordered by a state agency or by a local agency? (Check all that apply) Other: Mode of transmission, legal authority, insufficient/inappropriate action of local HDs, threat to public health, syndrome, jurisdictional considerations, recommendations from CDC consultants, Comments: State HD is sole authority to order iso/quar (5); not specified by rule, law, or policy

39. Are there different procedures for implementing GROUP isolation/quarantine versus INDIVIDUAL isolation/quarantine?

40. Does your state have an isolation and quarantine electronic tracking system that may be used independently by local public health agencies?

41. Does your state have a case management system for persons in isolation or quarantine that is integrated with other electronic systems, such as a NEDSS-compliant surveillance system?

42. Has the state public health agency identified incentives to enhance compliance of private citizens in a state-ordered isolation or quarantine? If an incentive program was developed, has it ever been employed?

43. How much time would be needed to obtain an isolation or quarantine order from the state health department following report of a physician-diagnosed quarantinable disease?

44. If the CDC issues a federal order for INDIVIDUAL or GROUP quarantine in your state, for which of the following areas would the state be willing to provide resources to implement and maintain that order? (Check all that apply) Comments: Unable to respond; depends on situation; not specified by statute, rule, or policy; CDC has no legal authority to mandate individual or group quarantine in my state; without a federal quarantine station, unsure how federal authority applies; in right circumstances would do all

45. Which of the following areas are too under-resourced in the state to effectively implement and maintain an INDIVIDUAL-level or GROUP-level isolation or quarantine? (Check all that apply) Comments: Situation dependent; legal restrictions- no MOUs in place to accommodate isolation or quarantine; little large scale capability

46. Which of the following locales is your state considering for use in group isolation/quarantine? (Check all that apply) Other: Designated mass care shelters, motels, hotels, casinos, correctional facilities, churches, community centers, airport hangars, colleges, military bases, gyms, homes, vacant State properties, nursing homes Comments: Have not discussed; have not been able to identify; we do not plan to do group isolation/quarantine

47. Has a preparedness checklist specific to isolation and quarantine been created by your state public health agency for use by the general public?

48. What percentage of the GENERAL PUBLIC in your state do you believe is prepared for an event requiring isolation or quarantine (i.e. plans in place; supplies readied)?

49. On a scale of 1-10, please rate your state public health agency's level of preparedness for the following activities related to isolation and quarantine. 1= not at all prepared 10= fully prepared

50. What type of exercises, if any, has the state public health agency conducted in the last 5 years to test group isolation and quarantine procedures and/or capabilities? (Check all that apply) Other: School closure exercises, participated in exercises led or co-led by with other agencies Comments: No plans for group isolation/quarantine