Authority and Actions of Health Officers to Prevent and Control
the Spread of Disease Denise Chrysler Michigan Department of
Community Health Legal Consultation Meeting October 12, 2007 Slide
2 Health Officers and the attorneys who assist them Using the law
to protect the public Powers of state and local health officers
Limitations on powers Enforcement of orders Inter-jurisdictional
issues Slide 3 Powers of Health Officers Defined by Michigan Public
Health Code Public health responsibilities are a joint function of
MDCH and local health departments Both state and local health
departments have broad powers to protect the public health
Michigans 45 local health departments have the primary
responsibility to protect human health within their jurisdictions
Slide 4 State Health Director MDCH Director provides leadership for
local public health services throughout state MDCH Director has
authority to govern actions of local health officers through her
orders or MDCH rules MDCH may exercise its authority where the
local health department does not or cannot adequately perform its
duties Slide 5 State Health Director, continued If MDCHs Director
determines that conditions anywhere in the state constitute a
menace to the public health, she is authorized to take full charge
of the administration of applicable state and local health laws,
rules, regulations, and ordinances. MCL 333.2251(3) Slide 6 General
Powers of Health Officers Powers necessary and appropriate to
perform their duties: Promoting and safeguarding the public health
Prolonging life Preventing and controlling the spread of disease
Slide 7 Powers Relating to Disease Prevention and Control Conduct
surveillance Inspect or investigate Impose measures to control the
spread of disease Go to court Adopt rules 6 Slide 8 Michigan Public
Health Code shall be liberally construed for the protection of the
health, safety, and welfare of the people of this state. MCL
333.1111(2) Slide 9 Power to Conduct Surveillance Disease reporting
requirements Syndromic Surveillance Hospital Emergency Departments
Over the Counter Sale of Drugs and Medical Devices Michigan Health
Alert Network Slide 10 Power To Inspect or Investigate Inspect or
investigate any matter, thing, premises, place, person, record,
vehicle, incident, or event to ensure compliance with laws Review
confidential information Obtain specimens Conduct contact
investigations Notify exposed individuals Slide 11 Investigations
identifiable health information Investigator shall promptly be
provided with medical and epidemiological information regarding:
Individuals who have/suspected of having disease Individuals,
whether sick or well, who are part of group in which has occurred
Individuals who may have been exposed Other individuals where
information is needed for investigation into cause or occurrence of
disease The patients consent is not required 9 Slide 12 HIPAA*
Privacy General Rule: A covered entity may not use or disclose
protected health information except as permitted or required by the
HIPAA privacy regulations. * Health Insurance Portability and
Accountability Act Slide 13 Permitted Disclosures to Prevent or
Control Spread of Disease To Public Health Authorities for the
purpose of preventing and controlling disease as authorized by
State Law To avert a serious threat to health or safety Slide 14
Memorandum State Health Director, Janet Olszewski Explains
requirements under state law with regard to disclosure of health
information for the prevention and control of disease. Explains
that HIPAA does not alter state requirements. Slide 15 Memorandum
State Health Director, Janet Olszewski HIPAA recognizes that health
providers may rely, if reliance is reasonable, on the statement of
the government regarding the legal authority under which the
protected health information is requested. Slide 16 Responsibility
to protect private health information Identifiable information
gathered in connection with an investigation is confidential and is
not open to public inspection without the individual's consent or
the consent of the individual's guardian, unless public inspection
is necessary to protect the public health as determined by a local
health officer or the director. Communicable Disease Rules, R
325.181(2) Slide 17 Power to Impose Measures to Control Spread of
Disease Emergency Orders Warning Notices Slide 18 Power to Issue
Emergency Orders Imminent Danger Order MCL 333.2251; 333.2451
Emergency Order to Control an Epidemic MCL 333.2253; 333.2453 Order
to Abate a Nuisance MCL 333.2455 14 Slide 19 Imminent Danger Order
Determine imminent danger Order necessary action that will avoid,
correct or remove the danger Deliver order to person authorized or
able to take corrective action Provide warning to affected
individuals or (where applicable) post notice at site of danger
Slide 20 Imminent Danger a condition or practice exists which could
reasonably be expected to cause death, disease, or serious physical
harm immediately or before the imminence of the danger can be
eliminated through enforcement proceedings otherwise provided Slide
21 Imminent Danger Orders Powerful Effective Fast Flexible Slide 22
Director Olszewski has issued orders to prevent animal carriers
from infecting humans Monkeypox Order(2003) Also, order regarding
pet rodents that carry lymphocytic choriomeningitis virus (LCMV)
(2005) Slide 23 Flu Vaccine Shortage Flu Vaccine Order Issued
October 14, 2004 Ordered all health care providers to limit
influenza vaccinations to persons in high risk categories Slide 24
Airline Passenger With Measles Exposure of 279 passengers on
Northwest Flight 39 from Amsterdam to Detroit Slide 25 Order
Requiring Production of Manifest Order issued on March 14, 2004
Required Northwest Airlines to immediately provide the Department
with names and contact information on all passengers and crew
members of Flight 39 Health officials used information to contact
individuals to inform them of exposure and provide information on
reducing possibility of infection Slide 26 Order to Control an
Epidemic Determine that control of an epidemic is necessary to
protect the public health Issue an order To prohibit the gathering
of people for any purpose To establish procedures to be followed by
persons during an epidemic to insure continuation of essential
public health services; to control spread of disease May be issued
against a local governmental entity May also issue a warning notice
for involuntary detention and treatment of individuals with
hazardous communicable disease Slide 27 Example: barrier
precautions be used by essential workers Policemen in Seattle
wearing masks made by the Red Cross, during the influenza epidemic.
December 1918. Photo of the National Archives Slide 28 If only they
were this easy Decisions and Recommendations Slide 29 Warning
Notice Against Carrier of Disease Issued against a carrier who is a
health threat to others Requires individual to cooperate in
preventing or controlling transmission of disease Notifies
individual that if he or she fails to comply, the health department
will seek a court order Informs individual that individual will
have a right to a hearing before court issues order, except in
emergency MCL 333.5203 Slide 30 Civil Enforcement Power to Go to
Court To compel compliance with Imminent Danger Order To compel
compliance with Emergency Order to Control Epidemic To obtain
warrant to inspect or investigate and to seize property To obtain
an injunction Emergency petition for court order against a carrier
Slide 31 Obtaining Warrant to Inspect or Investigate & Seize
Property Application for warrant may be filed by State or Local
Health Department Issued by Magistrate based on facts stated in
affidavit May authorize property to be seized May direct law
enforcement to assist health department in inspection or
investigation Slide 32 Emergency Action Against Carrier Upon the
filing of an affidavit by the health officer, the circuit court may
order the health department or a peace officer to take an
individual whom the court has reasonable cause to believe is a
carrier and is a health threat to others into custody and transport
the individual to an appropriate emergency care or treatment
facility for observation, examination, testing, diagnosis, or
treatment and, if determined necessary by the court, temporary
detention. MCL 333.5207(1) Slide 33 Criminal Enforcement A person
who violates an order of MDCH is guilty of a misdemeanor. MCL
333.2261 An individual may be arrested if the violation occurs in
the presence of a police officer, or the police officer has
reasonable cause to believe the individual violated the order. MCL
764.15(1) No criminal penalty in Public Health Code for violation
of local health officers order Slide 34 Administrative Enforcement
Compliance Order Authority to adopt schedule of administrative
fines Slide 35 Power to Make Rules MDCH promulgating rules under
the Administrative Procedures Act Communicable Disease Rules Local
Health Departments adopting regulations under the Public Health
Code Rules have the force of law Slide 36 Limitations on Power
Jurisdictional limitations Constitutional limitations Slide 37
Jurisdictional limitations Local health officers cannot act outside
the local health departments boundaries Indian land Federal land
(if state relinquished control) Foreign Diplomats International
travelers prior to entry into the United States (before clearing
customs) Slide 38 Jacobson v Massachusetts The liberty secured by
the Constitution on the United States to every person within its
jurisdiction does not import an absolute right to each person to
be, at all times and in all circumstances, wholly freed from
restraint. There are manifold restraints to which every person is
necessarily subject for the common good. 197 US 11 (1905) Slide 39
Constitutional limitations Due Process Substantive Procedural Equal
Protection Right to privacy Freedom of Association Freedom of
Religion Slide 40 Multi- and Inter-jurisdictional Issues Governors
declaration disaster or emergency Michigan Department of Community
Health Local Health Departments Local School Boards Universities
Federal government (Homeland Security, CDC, Agriculture, FDA, etc.)
Slide 41 Slide 42 Planning, protocols and agreements Plan Plan Plan
Response Plans Operations Plans Mutual Aid Agreements
ExerciseExerciseExercise Incident Command Slide 43 Resources? You
have done so much with so little for so long that Id like you to
move on to doing everything with nothing. Slide 44 Thank you for
your attention. Denise Chrysler (517) 373-2109
[email protected]
