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Judy Zeprun Kalman Senior Counsel Massachusetts Office of the Attorney General. Role of the AG in Preparing for and Responding to Public Health Emergencies. Authority of OAG. Represents the Commonwealth, as well as the secretary, agency, or department head who requests his appearance - PowerPoint PPT Presentation
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Judy Zeprun Kalman
Senior CounselMassachusetts
Office of the Attorney General
Role of the AG in Preparing for and Responding to Public Health
Emergencies
Authority of OAG
• Represents the Commonwealth, as well as the secretary, agency, or department head who requests his appearance
• Represents the public interest• Assumes primary control over conduct of
litigation which involves the interests of the Commonwealth
• Defends tort, civil rights, suits alleging other wrongful acts by officer or state employee
• Is a primary legal advisor to the Governor
Role of AG in Preparing/Responding to Public Health Emergency
• Role of AG :– To represent the state or authorize DPH or relevant
city or town to act as a Special AAG– To give legal advice– To require agencies to perform– To set aside agency action that exceeds its authority– To coordinate courses of action among the agencies– Proactively, to assure preparedness and effective
response for public health emergency
Example of Project in which OAG acted as Legal Advisor, Coordinator, Policy Maker, Collaborator,
Educator• OAG, as legal advisor to the DPH, collaborated
with DPH to: – develop best practices for I/Q– create legal documents that could be used in a public
health emergency– educate local authorities (boards of health, town
counsel, etc.) about their powers and duty to act in a public health emergency and the legal remedies available when voluntary isolation or quarantine was rejected
– educate the Superior Court about the project
Concepts
• Working together cross-agency
• Legal Powers and Duties
• Public Policy
• Legal Terms
• Isolation/Quarantine
Legal Duty
• “If a disease dangerous to the public health exists in a town, the selectmen and board of health shall use all possible care to prevent the spread of the infection . . .” (statutory)*
• Complimentary regulatory scheme
• “If we do that” vs. “If we don’t”* State DPH has “coordinate powers”
Legal Powers and Authority
• Police powers• Statutory authority of DPH and local boards of
health• Regulatory authority of DPH and local boards of
health• Includes the authority of the DPH or local board
of health to cause sick or infected person to be removed to a hospital
Good Policy: Escalating Steps for I/Q
• Education, persuasion for voluntary compliance– Request– Instruction letter– Monitoring
• Administrative Process – Administrative Order– Instruction letter– Monitoring– Warning that non-compliance might end in court order– Opportunity to challenge by phone call
Persuasion
• Request to remain isolated/quarantined• Medical information• Contact numbers for help• Remember:
– patients and their families will need social, psychological, other support
– build links in advance– be sensitive to cultural differences– the better your relationship with the patient and family,
the less likely you’ll have to go to court
Toronto Experience
• Persuasion vs. compulsion• 2132 potential cases of SARS• 23,000 contacts• 13,291 complied• 9812 were reached after quarantine period or
weren’t reached• 27 formal quarantine orders• 1 appeal (later withdrawn)
Administrative Process
• Letter to Patient• Letter to Patient who doesn’t have in-state
residence• Information packet for persons in home
isolation• Information packet for persons in home
quarantine• (Emergency) Administrative Order
Emergency Administrative Isolation Order
• Addressed to a particular patient• Outlines diagnosis• Describes danger to public health• Describes evidence that patient did not or will not
follow request to remain at home• Orders patient under appropriate authority to
isolate• Warns that failure to comply may result in court
order• Gives contact information for public health official
and for objection to the order
Translation Notice
How will isolation order be enforced?
• Work with local law enforcement in advance
• Seek court intervention, if necessary
Legal Process
• Application for court order by board of health and/or DPH– Upon a showing of medical necessity/danger
to the public– Upon a showing of non-compliance with
request or administrative order
Legal Process: Basic Concepts
• Overview of court system – where do I go?• Definition of Legal Terms, e.g., affidavit, ex parte
TRO, application for PI, etc.• The burden of proof
– Reasonable basis to believe– Likelihood of success on the merits
• The least restrictive alternative• The duty to act
Templates
• Background information• Time line• Complaint, Request for TRO, PI, Other Relief• Affidavits re: medical treatment and evaluation
and failure to comply• Designated Facility• Motion to Impound• Warrant
Local Authorities’ Role
• To act• To notify DPH• To complete affidavits• To set up EMS, police services, designated
facility in advance• To execute warrant• To attend hearing• Deal with emergency; handle administrative or
financial matters later
The Templates
• How to use
• How to modify
Minimizing Liability
• Training
• Liability for acting
• Liability for failure to act
• Using approved documents
Group Exercise no. 1
• The Board of Health has gone to court to obtain a warrant (court order) to remove the patient from his home to the hospital. It contacts the local ambulance service to transport the patient, but the local service declines and says no EMTs will transport the patient with the dangerous, communicable disease. What should the Board of Health do?
Group Exercise no. 2
• The Board of Health gets the patient transported to the hospital but the police chief refuses to assign a patrolman outside the patient’s door, saying, “Who’s going to pay for the overtime, you?”
Take Home Points
• Connectivity: meet with other officials in your city or town!
• Get to know your city or town solicitor
• Get to know your regional health educators and coordinators
• Review documents on CD-Rom.
THANK YOU
Judy Zeprun KalmanSenior CounselMassachusetts
Office of the Attorney General
Role of the AG in Preparing for and Responding to Public Health Emergencies
Emergency Management Law 101
Questions & Discussion
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