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Comparison of Health Laws
Audrey Kaiser Manka, J.D.Minnesota Assistant Attorney General
"The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.”
Health Laws Compared in this Talk
• Health Threat Procedures Act §§ 144.4171-.4186
• Tuberculosis Health Threat Act §§ 144.4801-.4813
• Isolation and Quarantine Statute §§ 144.419-.4195
Noncompliant Carrier
Minn. Stat. §§ 144.4171-.4186
Noncompliant TB Carrier Minn. Stat.
§§ 144.4801-.4813
Emergency Powers Minn. Stat.
§§ 144.419-.4195
Isolation Quarantine
Covered Individuals
Individual IndividualIndividual or Group
Individual or Group
Covered Individuals
Noncompliant Carrier
Minn. Stat. §§ 144.4171-.4186
Noncompliant TB Carrier Minn. Stat.
§§ 144.4801-.4813
Emergency Powers Minn. Stat.
§§ 144.419-.4195
Isolation Quarantine
Disease or Condition
1. Directly transmitted- sexually
transmitted- blood borne; or- direct or
intimate skin contact
2. Indirectly transmitted (any other transmission)
Tuberculosis(includes both infectious and non- infectious Tuberculosis)
Infected by new, novel, or previously controlled communicable disease or bioterrorism.
Likely to have been exposed to new, novel, or previously controlled communicable disease or bioterrorism.
Does not include directly transmitted diseases, i.e. STDs
Disease or Condition
Noncompliant Carrier
Minn. Stat. §§ 144.4171-.4186
Noncompliant TB Carrier Minn. Stat.
§§ 144.4801-.4813
Emergency Powers Minn. Stat.
§§ 144.419-.4195
Isolation Quarantine
Notice Health Directive,personally served in same manner as summons and complaint
Health Order, personally served by peace officer or disease prevention officer
Individual orders, or, if impracticable, group posting in conspicuous place. If posting is impractical, the Court must use the best means available. Notice rather than service.
Notice
Noncompliant Carrier
Minn. Stat. §§ 144.4171-.4186
Noncompliant TB Carrier Minn. Stat.
§§ 144.4801-.4813
Emergency Powers Minn. Stat.
§§ 144.419-.4195
Isolation Quarantine
Designation Health threat to others- Carrier demonstrates
an inability or unwillingness to act in such a manner as to not place others at risk of exposure to infection that causes serious disease, serious disability, or death.
i.e. repeated behavior that has been demonstrated epidemiologically to transmit the disease.
Endangerment to public health.- Carrier may
transmit the disease to others by certain conduct: i.e. - fails or refuses to
submit to examination
- misses 20% of appointments for DOT or two consecutive appointments
- fails or refuses to complete treatment
- fails or refuses to keep treatment appointments.
Infected and isolation is an effective control strategy.
Likely to have been exposed and quarantine is an effective control strategy.
Designation
Noncompliant Carrier
Minn. Stat. §§ 144.4171-.4186
Noncompliant TB Carrier Minn. Stat.
§§ 144.4801-.4813
Emergency Powers Minn. Stat.
§§ 144.419-.4195
Isolation Quarantine
Burden of Proof
- Reasonable cause for issuance of
apprehend and hold order or temporary emergency hold- Clear and convincing at court
hearing
- Probable cause to issue health order
- Preponderance of evidence at
preliminary hearing
- Clear and convincing evidence
at final hearing
- Standard for temporary hold: delay in I/Q would significantly jeopardize MDH’s ability to limit or prevent transmission- Probable cause to believe
I/Q is warranted at ex parte hearing
- Clear and convincing evidence at court hearing
Burden of Proof
Noncompliant Carrier
Minn. Stat. §§ 144.4171-.4186
Noncompliant TB Carrier Minn. Stat.
§§ 144.4801-.4813
Emergency Powers Minn. Stat. §§ 144.419-.4195
Isolation Quarantine
Enforce-ment Action
Health Directive↓
Petition to Enforce or
Temporary Emergency Hold to protect the public health (72 hours) - either apprehend and hold, if at
large, or- order health
facility to hold
Health Order ↓
Notice of Obligation to Isolate or Examine (72 hour hold which may be extended by ex parte order for up to 6 days)
or Apprehend and Hold
↓Preliminary hearing
↓Final hearing (periodic review every 90 days)
Temporary hold upon Commissioner’s Directive (lasts up to 48 hours; petition must be filed with the court within 24 hours, then the court must rule within 24 hours after receiving petition) orEx parte Court Order (lasts up to 21 days)
↓Unless Court hearing requested (to be held within 72 hours and may extend I/Q for 30 days)
↓Hearing on Conditions of Isolation or Quarantine
↓Released immediately when Commissioner determines no further need for isolation/ quarantine, or automatically upon expiration of court order
Enforcement Action
Noncompliant Carrier
Minn. Stat. §§ 144.4171-.4186
Noncompliant TB Carrier Minn. Stat.
§§ 144.4801-.4813
Emergency Powers Minn. Stat.
§§ 144.419-.4195
Isolation Quarantine
Location of Hearing
County where carrier resides
County where carrier resides; May be in a hearing room in treatment facility or court may designate another location
County where person is located or in an adjoining county, or Ramsey County (statewide jurisdiction)
Location of Hearing
Noncompliant Carrier
Minn. Stat. §§ 144.4171-.4186
Noncompliant TB Carrier Minn. Stat.
§§ 144.4801-.4813
Emergency Powers Minn. Stat.
§§ 144.419-.4195
Isolation Quarantine
Right to and Duties of Counsel
Recognizes right to counsel, including, if indigent, the right to court designated counsel.
Counsel shall: - consult with person prior to hearing
- be given adequate time to prepare
- continue representation until released by court
- be a vigorous advocate
Court appointed. Commissioner to provide certified copies of relevant medical records Duty to communicate:- statement of disputed facts
- names and addresses of witnesses and
summary of testimony
Recognizes right to counsel, including, if indigent, the right to court designated counsel.
Right to and Duties of Counsel
Noncompliant Carrier
Minn. Stat. §§ 144.4171-.4186
Noncompliant TB Carrier Minn. Stat.
§§ 144.4801-.4813
Emergency Powers Minn. Stat.
§§ 144.419-.4195
Isolation Quarantine
Court Ordered Measures
- Education- Counseling- Treatment- Medical tests- Monitoring- Cease and desist- Supervised living
- Isolate and detain for treatment
- Examination- Remain in treatment facility to complete course of treatment
- Exclude carrier from work or school as necessary
- Provide necessary medical and
epidemiological data- Testing of others in carrier’s household, workplace or school
- Follow contagion precautions
- Isolation- Quarantine
Court Ordered Measures
Noncompliant Carrier
Minn. Stat. §§ 144.4171-.4186
Noncompliant TB Carrier Minn. Stat.
§§ 144.4801-.4813
Emergency Powers Minn. Stat.
§§ 144.419-.4195
Isolation Quarantine
Appeal Rights
Court of Appeals shall hear appeal within 30 days
Court of Appeals shall hear appeal within 60 days
As per Minn. R. of Civ. Appellate Procedure
Appeal Rights