STANDARDS: AN OVERVIEW - San Francisco …€¦ · · 2012-04-13STANDARDS: AN OVERVIEW VERSION 1.0 APPLICATION PERIOD ... Engage with the Public Health System and the Community

STANDARDS:AN OVERVIEW

VERSION 1.0 APPLICATION PERIOD 2011–2012

APPROVED MAY 2011

Public Health Accreditation Board

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PHAB STANDARDS OVERVIEW2

DOMAIN 1: Conduct and disseminate assessments focused on population health status and public health issues facing the community

Standard 1.1: Participate in or Conduct a Collaborative Process Resulting in a Comprehensive Community Health Assessment

Standard 1.2: Collect and Maintain Reliable, Comparable, and Valid Data That Provide Information on Conditions of Public Health Importance and On the Health Status of the Population

Standard 1.3: Analyze Public Health Data to Identify Trends in Health Problems, Environmental Public Health Hazards, and Social and Economic Factors That Affect the Public’s Health

Standard 1.4: Provide and Use the Results of Health Data Analysis to Develop Recommendations Regarding Public Health Policy, Processes, Programs, or Interventions

DOMAIN 2: Investigate health problems and environmental public health hazards to protect the community

Standard 2.1: Conduct Timely Investigations of Health Problems and Environmental Public Health Hazards

Standard 2.2: Contain/Mitigate Health Problems and Environmental Public Health Hazards

Standard 2.3: Ensure Access to Laboratory and Epidemiologic/Environmental Public Health Expertise and Capacity toInvestigate and Contain/Mitigate Public Health Problems and Environmental Public Health Hazards

Standard 2.4: Maintain a Plan with Policies and Procedures for Urgent and Non-Urgent Communications

ASSESS

INVESTIGATE

DOMAIN 3: Inform and educate about public health issues and functions

Standard 3.1: Provide Health Education and Health Promotion Policies, Programs, Processes, and Interventions to Support Prevention and Wellness

Standard 3.2: Provide Information on Public Health Issues and Public Health Functions Through Multiple Methods to a Variety of Audiences

INFORM & EDUCATE

DOMAIN 4: Engage with the community to identify and address health problems

Standard 4.1: Engage with the Public Health System and the Community in Identifying and Addressing Health Problems Through Collaborative Processes

Standard 4.2: Promote the Community’s Understanding of and Support for Policies and Strategies That will Improve the Public’s Health

COMMUNITY ENGAGEMENT

DOMAIN 5: Develop public health policies and plans

Standard 5.1: Serve As a Primary and Expert Resource for Establishing and Maintaining Public Health Policies, Practices, and Capacity

Standard 5.2: Conduct a Comprehensive Planning Process Resulting in a Tribal/State/Community Health Improvement Plan

Standard 5.3: Develop and Implement a Health Department Organizational Strategic Plan

Standard 5.4: Maintain an All Hazards Emergency Operations Plan

POLICIES & PLANS

DOMAIN 6: Enforce public health laws

Standard 6.1: Review Existing Laws and Work with Governing Entities and Elected/Appointed Officials to Update as Needed

Standard 6.2: Educate Individuals and Organizations On the Meaning, Purpose, and Benefit of Public Health Laws and How to Comply

Standard 6.3: Conduct and Monitor Public Health Enforcement Activities and Coordinate Notification of Violations among Appropriate Agencies

PUBLIC HEALTH LAWS

PHAB STANDARDS OVERVIEW 3

DOMAIN 7: Promote strategies to improve access to health care services

Standard 7.1: Assess Health Care Capacity and Access to Health Care Services

Standard 7.2: Identify and Implement Strategies to Improve Access to Health Care Services

ACCESS TO CARE

DOMAIN 8: Maintain a competent public health workforce

Standard 8.1: Encourage the Development of a Sufficient Number of Qualified Public Health Workers

Standard 8.2: Assess Staff Competencies and Address Gaps by Enabling Organizational and Individual Training and Development

WORKFORCE

DOMAIN 9: Evaluate and continuously improve processes, programs, and interventions

Standard 9.1: Use a Performance Management System to Monitor Achievement of Organizational Objectives

Standard 9.2: Develop and Implement Quality Improvement Processes Integrated Into Organizational Practice, Programs, Processes, and Interventions

QUALITY IMPROVEMENT

DOMAIN 10: Contribute to and apply the evidence base of public health

Standard 10.1: Identify and Use the Best Available Evidence for Making Informed Public Health Practice Decisions

Standard 10.2: Promote Understanding and Use of Research Results, Evaluations, and Evidence-based Practices With Appropriate Audiences

EVIDENCE-BASED PRACTICES

DOMAIN 11: Maintain administrative and management capacity

Standard 11.1: Develop and Maintain an Operational Infrastructure to Support the Performance of Public Health Functions

Standard 11.2: Establish Effective Financial Management Systems

ADMINISTRATION & MANAGEMENT

DOMAIN 12: Maintain capacity to engage the public health governing entity

Standard 12.1: Maintain Current Operational Definitions and Statements of the Public Health Roles, Responsibilities, and Authorities

Standard 12.2: Provide Information to the Governing Entity Regarding Public Health and the Official Responsibilities of the Health Department and of the Governing Entity

Standard 12.3: Encourage the Governing Entity’s Engagement In the Public Health Department’s Overall Obligations and Responsibilities

GOVERNANCE

The PHAB STANDARDS apply to all health departments—Tribal, state, local, and territorial. Standards are the required level of achievement that a health department is expected to meet. Domains are groups of standards that pertain to a broad group of public health services. The focus of the PHAB standards is “what” the health department provides in services and activities, irrespective of “how” they are provided or through what organizational structure. Please refer to the PHAB Standards and Measures Version 1.0 document, available at www.phaboard.org, for the full official standards, measures, required documentation, and guidance.

Public Health Accreditation Board • Standards & Measures Version 1.0 • Approved May 2011242

Standard 12.1 Maintain Current Operational Definitions and Statements of the Public Health Roles, Responsibilities, and Authorities

Standard 12.3 Encourage the Governing Entity’s Engagement in the Public Health Department’s Overall Obligations and Responsibilities

Domain 12: Maintain capacity to engage the public health governing entity

Domain 12 focuses on the health department’s capacity to support and engage its governing entity in maintaining the governmental public healthinfrastructure for the jurisdiction served. Governing entities play an important role in the function of many public health departments. Governing entitiesboth directly and indirectly influence the direction of a health department and should play a key role in accreditation efforts. However, much variationexists regarding the structure, definition, roles, and responsibilities of governing entities.

A governing entity, as it relates to the accreditation process, should meet the following criteria:1. It is an official part of Tribal, state, regional, or local government.2. It has primary responsibility for policy-making and/or governing a Tribal, state, or local, health department.3. It advises, advocates, or consults with the health department on matters related to resources, policy making, legal authority, collaboration, and/or improvement activities.

4. It is the point of accountability for the health department.5. In the case of shared governance (more than one entity provides governance functions to the health department), the governing entity, foraccreditation purposes, is the Tribal, state, regional, or local entity that, in the judgment of the health department being accredited or PHAB sitevisitors, has the primary responsibility for supporting the applicant health department in achieving accreditation.

DoMain 12 incluDes three stanDarDs:

Standard 12.2 Provide Information to the Governing Entity Regarding Public Health and the Official Responsibilities of theHealth Department and of the Governing Entity

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stanDarD 12.1 : Maintain current oPerationalDeFinitions anD stateMents oF PuBlic health roles,resPonsiBilities, anD authorities.

A governmental public health department operates with specific authorities to protect and preserve the

health of the population within its jurisdiction. These authorities may be set forth in state statute, rules and

regulation, local ordinances, administrative code, charters, or resolutions. Authorities may be regulatory or

programmatic. This standard assures that the health department understands its authority and that of its

governance entity for the department’s roles and responsibilities and that such authority is put into practice.


standard 12.1: Maintain current operational definitions and statements of public health roles, responsibilities, and authorities.

Required Documentation

1. Authority to conduct public health activities

Guidance

1. The health department must provide a copy of the body of law (statutes, rules, regulations,ordinances) that sets forth its mandated public health operations, programs, and services or a listing of mandated public health services and the reference to the legal citation. The healthdepartment must have copies or access to the laws and regulations available to the site visit team.

An example is the disease reporting rules or regulations reflected by the Council of State andTerritorial Epidemiologist’s list of Nationally Notifiable Conditions. Other examples include:mandated vaccinations; mandated oversight of environmental public health conditions, suchas solid waste, small public water systems, underground storage tanks, and hazardousmaterials; and various inspection programs, such as restaurant inspections.

Examples of documentation for Tribal health departments may include: Tribal resolution,ordinance, or executive order.

Measure

12.1.1 AProvide mandated public health operations,programs, and services

Purpose

The purpose of this measure is to assess thehealth department’s knowledge and provisionof the operations, programs, and services thatit is mandated to provide and that thosemandates are put into action.

Significance

Each health department has a set ofmandated operations, programs, andservices that it provides to protect andpreserve the health of the population withinthe jurisdiction that it serves. It is importantthat the health department is knowledgeableof these mandates and performs them asrequired.



2. Description of operations that reflectauthorities

Guidance

2. The health department must provide a written description that shows how the healthdepartment implements the mandated responsibility through a process, program, orintervention. Documentation can be service descriptions, annual reports, meeting minutes,reports to governance, functional descriptions, organizational descriptions, or other written material.

Measure 12.1.1 a, continued


standard 12.1: Maintain current operational definitions and statements of public health roles, responsibilities, and authorities.


1. Authority of the governing entity

2. Description of governing entity

Guidance

1. The health department must provide a written description of its governing entity’s authority.Documentation could be a copy of the body of law (statutes, rules, regulations, ordinances)that sets forth the mandated authority, or a description of the authority and the reference tothe legal citation. Examples of documentation for Tribal health departments may include Tribalresolution, ordinance, or executive order.

2. The health department must provide a written description of the governing entity. Thegoverning entity could be, for example, a board of health, a governor’s office, countycommissioners, or other point of accountability. Documentation could be a statute, rules,regulations, a charter, a charge statement, or other written description.

Measure

12.1.2 AMaintain current operational definitions and/orstatements of the public health governingentity’s roles and responsibilities

Purpose

The purpose of this measure is to assess thehealth department’s knowledge of thegoverning entity’s operational definition and/orgoverning entity’s roles and responsibilities.

Significance

The health department should have a clearunderstanding of expectations for itsaccountability. The governing entity is that pointof accountability, and the health departmentshould understand the governing authority’sstructure, responsibilities, and expectations.


stanDarD 12.2: ProViDe inForMation to the GoVerninGentitY reGarDinG PuBlic health anD the oFFicialresPonsiBilities oF the health DePartMent anD oF theGoVerninG entitY.

The governing entity is the point of accountability for the health department. The governing entity is

accountable for the health department achieving its mission, goals and objectives to protect and preserve

the health of the population within its jurisdiction. This standard addresses the health department’s

capacity for keeping the governing entity updated on the department’s overall legal authority, obligations

and responsibilities, and on the governing entity’s supporting role.


standard 12.2: Provide information to the governing entity regarding public health and the official responsibilities of the health department

and of the governing entity.


1. Two examples of communications providedto the governing entity regarding theresponsibilities of the public healthdepartment

Guidance

1. The health department must provide two examples of communication to the governing entityon the health department’s official responsibilities. Documentation should demonstrate theprocess of informing the governing entity about the responsibilities of the health department.The health department should select its documentation for this measure based on the modelof governance in place for the health department. Documentation could be reports,testimonies, speeches, presentations, or emails.

Measure

12.2.1 A Communicate with the governing entityregarding the responsibilities of the publichealth department

Purpose

The purpose of this measure is to assess thehealth department’s communications with itsgoverning entity regarding the healthdepartment’s responsibilities.

Significance

Governing entities significantly influence thedirection of health departments through policymaking and other similar activities. As a result,they may heavily influence whether healthdepartments are fulfilling their responsibilities.The health department must educate thegoverning entity about the department’sresponsibilities.


standard 12.2: Provide information to the governing entity regarding public health and the official responsibilities of the health department

and of the governing entity.


1. One example of a communication with thegoverning entity about their operationaldefinitions and/or statements of the publichealth governing entity’s roles andresponsibilities

Guidance

1. The health department must provide one example of sharing with the governing entityoperational definitions and/or statements of the public health governing entity’s roles andresponsibilities. The health department should select its documentation for this measurebased on the model of governance in place for the health department. Documentation couldbe in the form of meeting minutes, memos, emails, briefing papers, or other correspondence.

Measure

12.2.2 ACommunicate with the governing entityregarding the responsibilities of the governing entity

Purpose

The purpose of this measure is to assess thehealth department’s communications with itsgoverning entity concerning the roles andresponsibilities of the governing entity.

Significance

Many governing entities have key roles inresources, policy making, legal authority,collaboration, and/or improvement activities.The governing entity, to be an effectiveadvocate for public health and for the agency,must be aware of its responsibilities and duties.This information should include orientation fornew governing entities and new governingentity members, as well as for routine updates.While Domain 6 relates to the governing entity’srole in reviewing and updating specific laws,rules and regulations, this measure targets theoverall public health responsibilities that thegoverning agency oversees or advises,including training on those responsibilities.


stanDarD 12.3: encouraGe the GoVerninG entitY’senGaGeMent in the PuBlic health DePartMent’soVerall oBliGations anD resPonsiBilities.

Public health governing agencies exercise a wide range of responsibilities, including: advisory, statutory,

personnel, property ownership, taxing authority, public health rule-making, policy-making, and budgetary.

These responsibilities demand that the governing entity is well-versed in public health and in the work of

the health department. The governing entity and the health department should communicate regularly on

health department issues, program activities, and improvement activities.


standard 12.3: encourage the governing entity’s engagement in the public health department’s overall obligations and responsibilities.


1. Two examples of communications with thegoverning entity regarding important publichealth issues and/or recent actions of thehealth department

Guidance

1. The health department must provide two examples of information exchange between thehealth department and the governing entity. Communication exchanges include discussionsor dialogue with the governing entity regarding public health issues. These could bedemonstrated through reports, testimonies, formal meeting minutes, meeting summaries,program updates, reports on identified public health hazards, community health assessmentfindings, community dashboards, outbreak and response efforts, annual statistical reports, orother written correspondence (memos, emails), and other informal approaches.

Measure

12.3.1 A Provide the governing entity with informationabout important public health issues facingthe health department and/or the recentactions of the health department

Purpose

The purpose of this measure is to assesshealth department communications to keepthe governing entity informed of public healthissues and health department activities.

Significance

The health department needs to communicatewith its governing entity to ensure that thegoverning entity’s policies and decisions areinformed. A regular flow of information helpsto ensure that the governing entity acts in thebest interests of the public’s health.Information also needs to flow from thegoverning entity to the health department toensure mutual understanding of policy optionsand implications.




1. Review issues discussed, actions taken,and policies set by the governing entity atleast annually

Guidance

1. The health department must provide documentation that it reviewed the governing entity’sdiscussions of issues, actions taken, and policies set. The reviews of governing entity’sdiscussions, actions, and policies must take place at least annually. Reviews should include:an assessment of public health successes, patterns of issues, and/or topic or issue areaswhere increased communication is desirable. Documentation could be meeting minutes,reports, dashboards, presentations, memos, or other record of discussion of governing entity actions.

Measure

12.3.2 ATrack actions taken by the governing entity

Purpose

The purpose of this measure is to assess thehealth department’s review of the governingentity’s actions in order to identify publichealth successes, patterns of issues, and/orareas for increased communication.

Significance

The health department should thoroughlyunderstand the priorities, policy positions,opinions, and actions of the governing entityin order to continually improve communicationand effectiveness.




1. Two examples of communication with thegoverning entity concerning assessment ofthe health department’s performance

2. Two examples of communication with thegoverning entity concerning theimprovement of the health department’sperformance

Guidance

1. The health department must provide two examples of communications with the governingentity on its plans and process for improving health department performance. The healthdepartment should select its documentation for this measure based on the model ofgovernance in place for the health department. Examples of improvement efforts couldinclude: program reviews, accreditation efforts, quality improvement projects, and otherperformance improvement activities. Documentation could be meeting minutes, reports,presentations, memos, or other discussion records.

2. The health department must provide two examples of communication with the governingentity on its performance improvement as a result of performance improvement processesand/or activities. The health department should select its documentation for this measurebased on the model of governance in place for the health department. Documentation couldinclude: annual reports, department dashboards, program reviews, meeting minutes, reports,presentations, memos, or other record of discussion.

Measure

12.3.3 ACommunicate with the governing entity aboutassessing and improving the performance ofthe health department

Purpose

The purpose of this measure is to assess thehealth department’s communication with thegoverning entity on assessing and improvingthe overall performance of the healthdepartment.

Significance

The governing entity should beknowledgeable about the health department’soverall assessment and quality improvementinitiatives. The governing entity will be in abetter position to guide, advocate for, andengage with the health department if they areaware of improvements being undertaken.

HEALTH OFFICER PRACTICE GUIDE FOR COMMUNICABLE DISEASE CONTROL

IN CALIFORNIA (Revised 1/1/07)

This practice guide is a collaborative project of the Public Health Law Work Group. It was originally drafted by several County Counsel and City Attorney Offices in conjunction with the Office of Legal Services, State Department of Health Services, and edited by several Health Officers. It was then reviewed and edited by representatives of the California Conference of Local Health Officer, County Health Executives Association of California and the California Department of Health Services. It was published on December 14, 2005. The original document was supported by funds from the Centers of Disease Control and Prevention’s Cooperative Agreement on Public Health Preparedness. Following the initial publication of the practice guide, many suggestions and comments were provided to improve the presentation and content of the document. This version of the practice guide responds to many of the comments and suggestions received, and updates the document to reflect changes in the law. It was reviewed by the Public Health Law Workgroup following its December 6, 2006 meeting, and only one further comment was received. Your further comments on this practice guide are welcome. Please send your comments to Robert Tousignant by e-mail [email protected] or fax (916) 440-7710.

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II. GENERAL AUTHORITY OF THE HEALTH OFFICER.

A. HEALTH OFFICER DEFINED.

For purposes of the Communicable Disease Prevention and Control Act, the term “Health Officer” is defined to include county, city and district Health Officers, and city and district health boards, but does not include advisory health boards.2 Although the county Health Officer is not defined specifically as the “local health officer” in statutes dealing with communicable disease control, several Health and Safety Code sections define the two terms interchangeably, e.g., “health officer” or “local health officer,” each of which includes his or her designee.3

B. SOURCES OF HEALTH OFFICER AUTHORITY.

1. Appointment by the Governing Body.

The position and powers of the Health Officer derive from statute, but the appointment of each Health Officer is based upon the actions of the local governing body.4 The statutes authorize the appointment of a Health Officer in each county and city5 and the purpose for which each position is filled by the local authority.6 The Health Officer is required to observe and enforce (1) local orders and ordinances pertaining to the public health; (2) orders prescribed by the State Department of Health Services (DHS); and (3) statutes relating to the public health. Health Officers appointed by county Boards of Supervisors can act as a city Health Officer, if the city by ordinance, resolution, or contract designates the county Health Officer to be the city Health Officer.7

2. Local Ordinances and Resolutions.

Under the California Constitution, cities and counties may enforce within their limits “all local, police, sanitary, and other ordinances and regulations not in conflict with general laws.”8 The governing body of each city and county is required by statute to take measures necessary for the preservation and protection of the public health, including the adoption, if indicated, of ordinances and

2 California Health and Safety Code, (hereinafter, “H&S”), §120100 et seq. 3 H&S §120115(k), 17 California Code of Regulations (hereinafter, “C.C.R.”), §§2501 and 2641.50. 4 Pursuant to H&S §101025, the board of supervisors of each county derives authority to preserve and protect the public health in the unincorporated areas of each county by ordinance, regulations, and orders not in conflict with general law. The county health officer position is authorized by H&S §101000. The governing body of a city derives authority to preserve and protect the public health by regulation and adoption of ordinances, regulations, and orders pursuant to H&S §101450. The city health officer position is authorized by H&S §101460, which also provides authority for the city to make such an appointment. 5 H&S §§101000, 101460. 6 H&S §§101025,101030;101375,101400;101405,101415,101450, and 101470. 7 H&S §§101375, 101400. 8 California Constitution, Article, (hereinafter, “Cal. Const., art.”), XI, Section 7 “A county or city may make and enforce within its limits all local, police, sanitary, and other ordinances and regulations not in conflict with general laws.”

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resolutions not in conflict with the general laws.9 It is the duty of the Health Officer to enforce these ordinances and resolutions.

3. State Statutes.

The Health and Safety code contains the statutes pertaining to communicable disease prevention and control as well as the authority of the Health Officer.10

4. DHS Regulations and Orders.

Title 17 of the California Code of Regulations contain the regulations of DHS applicable to Health Officers.11 In addition to the regulations, DHS may issue direct orders to Health Officers. The Health Officer must, when required by DHS, act to enforce all DHS orders, rules and regulations.12 When the public health is menaced, the Health Officer’s actions may be controlled and regulated by DHS.13 DHS regulations and orders set the minimum measures to be observed by the Health Officer. The Health Officer may take more stringent measures where circumstances require. For a more extensive discussion of the powers of DHS, see Section V, “Interjurisdictional Coordination and Cooperation.”

C. HEALTH OFFICER AUTHORITY TO INVESTIGATE AND REPORT DISEASE.

DHS is mandated to create a list of reportable diseases and conditions. Specified providers of health care and under certain circumstances, individuals are required by regulation to report those diseases and conditions to the Health Officer14 and Health Officers in turn, must report specified diseases to DHS.15 In addition, Health Officers may require providers of health care in their respective jurisdictions to disclose a disease that is not listed in the DHS regulations.16

Health Officers are also the agent of DHS for conducting certain studies17 and undertaking investigations and actions as directed by DHS.18 Health Officer’s disclosure

9 H&S §101025. 10 Division 105 of the H&S, starting at §120100. Division 105 consists of several 'Parts', entitled (1) “Administration of Communicable Disease Prevention and Control,” (2) “Immunizations,” (3) “Sexually Transmitted Disease,” (4) “Human Immunodeficiency Virus (HIV),” (5) “Tuberculosis,” (6) “Veterinary Public Health and Safety,” and (7) “Hepatitis C.” These statutes can be accessed online at “www.leginfo.ca.gov/calaw”. 11 See 17 C.C.R. §2500 and following. Under H&S §100275, DHS is authorized to adopt regulations for the execution of its duties. 12 H&S §§120130, 120145, 120190, 120195, 120200, 120210, 120215 and 120175. 13 H&S §100180. 14 H&S §120130, under which DHS must establish and publish a list of reportable diseases and conditions. The list is found in 17 C.C.R. §2500 and includes the reporting of any unusual disease and outbreaks of any unlisted disease. 15 H&S §120130 mandates the Health Officer to report diseases as required by DHS. 17 C.C.R. §2500(g) requires the Health Officer to report information to DHS as requested. 17 C.C.R. §2500(d) mandates the Health Officer to report health care provider reports to DHS. Unless there is a written authorization, the information requested does not include drug and alcohol records protected by the Part 2 of Title 42 of the Code of Federal Regulations, (hereinafter, “C.F.R.”). 16 H&S §120175. 17 17 C.C.R. §2501. The Health Officer is required to conduct morbidity/mortality studies at DHS request.

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of information is governed by the California Code of Regulations (CCR),19 the Health Insurance Portability and Accountability Act of 1996 (HIPAA),20 the Confidentiality of Medical Information Act contained in California Civil Code §56.10, and may be subject to various other confidentiality statutes, some of which are described in Section VI, “Confidentiality Of Health Information.”

The primary purpose of these reporting requirements is to alert Health Officers to the presence of disease within their jurisdiction.21 Upon receiving a report of communicable disease, Health Officers shall take whatever steps as may be necessary for the investigation and control of spread of the disease, condition or outbreak reported. Under DHS regulations, the Health Officer must provide for an examination of the person or animal in order to verify the diagnosis, existence, or outbreak of the disease, investigate the source and take appropriate steps to prevent or control the spread of the disease.22

In circumstances involving an “immediate menace to the public health” caused by calamity, such as flood, storm, fire, earthquake, explosion, accident, or other disaster, the Health Officer may close the area where the menace to public health exists.23

D. HEALTH OFFICER AUTHORITY TO PREVENT AND CONTROL COMMUNICABLE DISEASE.

In order to receive state funding, Health Officers must provide: "Communicable disease control, including availability of adequate isolation facilities, and the control of acute communicable diseases..., based upon provision of .... appropriate preventive measures for the particular communicable disease hazards in the community."24 To fulfill this requirement, Health Officers are authorized to control contagious, infectious, or communicable disease and may “take measures as may be necessary” to prevent and control the spread of disease within the territory under their jurisdiction.25 This statutory provision alone can authorize all manner of measures taken by Health Officers, provided that the measures are necessary to prevent the spread of disease. In the sections of this practice guide that address specific measures, the section will commence with a discussion of this general authority, followed by a discussion of the statutes that specifically authorize the particular measure. For example, the general authority can be cited to support the imposition of isolation or quarantine. However, the Health Officer

18 17 C.C.R. §2502. The Health Officer is the agent of DHS when conducting morbidity/mortality investigations and exercising DHS investigation and action powers granted by Government Code (hereinafter, “Gov.”), §11181. DHS is also authorized to conduct such studies pursuant to H&S §100325. Gov. §11181 permits DHS inspection of books, records and other items. Therefore the Health Officer acting at DHS direction and has the same authority to inspect records. 19 17 C.C.R. §2500(f) and (g). The Health Officer may report to the DHS in confidence certain confidential medical information, other than drug and alcohol information, unless written authorization for such information is obtained. 20 45 C.F.R., Parts 160 and 164. 21 If the disease is not yet present within the Health Officer’s jurisdiction, the Health Officer may take preventative steps to control spread of disease into the jurisdiction. H&S §120175 and 17 C.C.R. §2501. 22 17 C.C.R. §2501 23 Penal Code (hereinafter, “Pen.”), §409.5. 24 17 C.C.R §2501. 25 H&S §120175.

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has additional statutory authority to isolate and quarantine,26 including on a mass level so long as the quarantine is not imposed on another city or county without the consent of DHS. 27 This is discussed with more detail in Section VIII, “Limiting the Movement of Individuals and Groups.”

This general authority may also include the ability to close or restrict public assemblies or gatherings, require evacuation, examination, inspection, vaccination, decontamination, disinfection, property destruction or commandeering, and to compel assistance. Each of these potential actions will be addressed more directly in the sections that follow. Commencing January 1, 2007, during an outbreak of communicable disease, or when there is imminent and proximate threat of such an outbreak, the Health Officer may request that health care providers within his or her jurisdiction disclose inventories of critical supplies, equipment, drugs, vaccines and other products that may be used for the prevention of the transmission of the disease. The Health Officer must maintain the confidentiality of this information.28

E. HEALTH OFFICER’S JURISDICTIONAL TERRITORY AND ENFORCEMENT

OF HEALTH OFFICER ORDERS.

The Health Officers’ general powers authorize him or her to act in the unincorporated areas of the county29 and those of the city Health Officer authorize action within the city’s borders.30 A city may by ordinance, resolution or contract authorize the enforcement of public health laws by the county Health Officer within the city. A county may contract with a city for the enforcement of public health laws by the city in county’s jurisdiction. City and county Health Officer enforcement authority in each other’s jurisdiction may be authorized by agreement.31

The enforcement of the communicable disease control laws is generally initiated by an order from the Health Officer that an individual act or refrain from acting in a particular manner. An individual must comply with the Health Officer’s orders, or risk civil or criminal sanctions.32 These sanctions can include up to and including fines and imprisonment, depending upon the nature of the circumstances. Issues of enforcement are addressed in more detail in Section IV, “Enforcement of Health Officer Authority.”

26 H&S §120130 (c); H&S §121365 (g) provides specific authority for the local health officer to require isolation. 27 The authority to require a mass quarantine is implied by a reading of H&S §120175 (control of contagious, infectious and communicable disease) in conjunction with H&S §120205. The Health Officer may impose mass quarantine as directed by DHS pursuant to H&S §§120145 and 120195. 28 H&S §120176 (added by Stats. 2006, c. 874 (SB 1430)). 29 H&S §101030 (for a county Health Officer). 30 H&S §101470 (for a city Health Officer). 31 H&S §§101375, 101400, 101405 and 101415. 32 H&S §100182 and Pen. §409.5(c).

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F. HEALTH OFFICER POWERS, DUTIES AND RESPONSIBILITIES ARE CIRCUMSCRIBED BY CONSTITUTIONAL LIMITATIONS.

Although Health Officers are statutorily mandated to take all necessary measures to prevent the transmission of disease, and with it the attendant authority to enforce orders,33 such power is not unlimited. Because the Health Officer’s exercise of authority may impact, curtail or impair an individual’s protected rights and liberties, constitutional considerations may arise. See Section III, “Constitutional Limitations Impacting Authority of the Health Officer.”

G. HEALTH OFFICER AUTHORITY TO DECLARE A HEALTH OR LOCAL EMERGENCY.

In situations involving hazardous and or medical waste release that is an immediate threat to the public health, or whenever there is an imminent and proximate threat of the introduction of any contagious, infectious, or communicable disease, chemical agent, noncommunicable biologic agent, toxin, or radioactive agent, Health Officers may declare a “local health emergency.”34 The Health Officer cannot declare a local emergency under the Emergency Services Act35 unless expressly granted that authority by the local governing body.36 Few California counties have granted such short term authority to its Health Officer. Any formal declaration of local emergency or local health emergency issued by a Health Officer must be ratified by the local governing body within a very limited number of days to remain effective. The declaration of a local health emergency authorizes other political subdivisions and state agencies to provide mutual aid. It also provides immunity to physicians, hospitals, nurses, and other specified persons providing medical care at the express or implied request of the Health Officer.37

33 In re Martin (1948) 83 Cal.App.2d 164, 167. 34 H&S §101080. 35 Gov. §§8550 et. seq; H&S §101310. 36 As noted in the Introduction, this guide is intended only to address those circumstances arising prior to the formal Declaration of Emergency. DHS has published a comprehensive document for such circumstances. See: Authority and Responsibility of Local Health Officers in Emergencies and Disasters, D. David Abbott [Emergency Preparedness Office] and Jack S. McGurk, (Chief of Environmental Management Branch), Department of Health Services, State of California (September 30, 1998). 37 H&S §101085(b) (added by Stats. 2006, c. 874 (SB 1430)).

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