Welcome Expert Panel on Isolation and Quarantine June 2-3, 2009 1.

Welcome

Expert Panel on Isolation and QuarantineJune 2-3, 2009

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Meeting Goals and ObjectivesGoals• Determine how the law can facilitate best practices and policies in

isolation and quarantine in the states • Make recommendations for best practices in isolation and quarantine law,

policy, and practice using data from the national survey and legal review• Identify data gaps and ambiguities in current laws, policies and practices

of isolation and quarantine in the states

Objectives• Review survey findings regarding policies and the practice of isolation and

quarantine in the states• Review survey findings of legal practice in states and compare with

national review of isolation and quarantine laws in states• Engage in iterative group process to identify best practices in isolation and

quarantine law, policies and practice2

Best Practices in Isolation and Quarantine

Isolation/Quarantine Expert PanelJune 2, 2009

UM Office of Public Health Practice

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Overview

• Survey Response• Policy and Practice• Legal Basis

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State Survey Response

• Pilot tested in four states• Survey administered by CSTE• 80% (41/51) completion rate by 50 states + D.C.• 78% of surveys were completed by State

Epidemiologist (designated key informant)• 73% consulted state legal advisor• # of responses varied by question

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Policy and Practice

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Number of Times in Past 5 years States have Invoked Isolation and/or Quarantine

(n=39 for Individuals, n=35 for Groups)

Policy and Practice

• Q & I Decisions and Procedures– 97% consider scientific concerns important or very important in

ordering Q & I (95% to terminate Q & I)– Legal concerns were important or very important in isolation (79%)

and quarantine (76%)– 53% had different procedures for implementing group versus

individual quarantine– 28% have an electronic tracking system for Q & I– 78% of states do not have incentives to enhance compliance

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Policy and PracticeCriteria used to ORDER and TERMINATE isolation and quarantine

1=not important 2=of little importance 3=moderately important 4=important 5=very important

ORDER 1 2 3 4 5Response Count

Scientific (specific disease, transmission patterns, magnitude, severity, etc.)

0 0 1 26 12 39

Resources (available personnel, funding, logistical restrictions, etc.)

2 9 22 3 2 38

Legal (authority, etc.) 1 1 5 25 7 39Political (public pressure, legislative action, media attention, etc.)

8 14 14 1 1 38

TERMINATE 1 2 3 4 5Response Count

Scientific (specific disease, transmission patterns, magnitude, severity, etc.)

0 0 2 25 11 38

Resources (available personnel, funding, logistical restrictions, etc.)

4 8 21 4 2 39

Legal (authority, etc.) 2 1 6 24 5 38Political (public pressure, legislative action, media attention, etc.)

8 13 14 3 1 39

Policy and Practice

• Q & I Responsibility– State Health Officer (82%) and Local Health Officer (67%) most often

have decision-making authority regarding quarantine and isolation of individuals and groups

• State Epidemiologist is primary advisor to State Health Officer on Q & I

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Policy and Practice

Q & I Component State Public Health

Local Public Health

Law Enforcement

Hospitals NGOs Other

Monitoring compliance

X X

Providing basic necessities to people

X X

Medical and mental health evaluation and treatment

X X

Social support services X X

Systems support X X

Funding support X X

Transport of persons X X

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Organizations with primary responsibility for Q & I orders

• To maintain group Q & I, states are under-resourced in funding support (66%), physical infrastructure (66%), and human resources (61%)

Policy and Practice

• Response Coordination– 80% of states engage local public health before making Q & I decisions– 87% coordinate Q & I roles and responsibilities with local public health– Tribal health boards (31%) and Indian Health Services (15%) have

rarely been engaged

• Q & I Orders– 90% of states could obtain a Q & I order within 24 hours– 8% could obtain one in 24 to 48 hours

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Policy and Practice

• Primary payers for healthcare during Q & I– Insured patient

• Private insurance (76%)• State health department (32%)

– Uninsured patient• Healthcare facility (57%)• State health department (49%)

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Policy and Practice

• Q & I Preparedness– 20% of states have not conducted any exercise of Q & I– 64% of states reported that ‘10 percent or less’ of the

general public is ready for a Q & I order– 51% of states with public education campaigns have

focused on the general public• 32% targeted non-English speaking populations

– 45% of states used Pandemicflu.gov for the public education campaign

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Legal Basis

• Legal procedure mandates– 87% of states have statutes, regulations or both for

individual due process– 70% for group due process– 72% mandate “least restrictive alternative”– 46% of states regulate implementation of due process

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Legal Basis

• Legal Authority– Most statutes and regulations deal with Q & I at the individual level as

opposed to group level– 65% have written formal guidance on how to proceed with Q & I

orders– Chief Counsel (71%) and Attorneys General (44%) most often serve as

legal advisors– 55% of states agree CDC has legal authority to mandate Q & I– 16 states have MOUs with partner agencies on Q & I

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Legal Basis Independent legal decision-making authority to declare an emergency for epidemics or other communicable disease

threats and/or implement isolation and quarantine of

Emergency Declaratio

ns

Quarantine of

Individuals

Isolation of

Individuals

Quarantine of

Groups

Isolation of

Groups

Response Count

Governor 39 9 9 9 9 39State Health Officer 6 35 35 32 33 35Chief Medical Executive

0 3 3 3 3 3

State Epidemiologist 0 4 4 5 4 5State Director of Emergency Preparedness

0 0 0 0 0 0

Local Health Officer 2 27 27 23 23 27Other 3 6 5 7 5 10Others:

Municipal and county governments; physician designated by State Health Officer; county or city chief executive official; 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

Legal Basis

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Since last Revised (N=41) Since last Reviewed (N=39)

< 2 years 24.4% 61.5%

2 to 5 years 41.5% 35.9%

6 to 10 years 7.3% 2.6%

> 10 years 26.8% 0%

Years since Q & I laws Revised/Reviewed