Bioterrorism

One major concern of the public health system today is isolation and quarantine. When is the use of isolation and/or quarantine appropriate? Who is authorized to make that final decision and what are the procedures involved? Further, what's the most effective way of doing it and how can the public health system be better prepared to deal with it? As Margaret Hamburg states in the states in her 2001 article, "Challenges Confronting Public Health Agencies", published in Health Report:

All these questions involve many different levels of government and many different laws and authorities and raise many complex and intertwined ethical issues. In a systematic and coherent way, we must address this array of pressing issues and concerns, and not just what laws are in place or could be put in place but also what policies and procedures would be necessary to actually implement them. (Hamburg, p.5)

The first things the public health system must be aware of are the current laws in place governing the use and implementation of isolation and quarantine. This is a very complex issue because not only does this require a general knowledge of the federal guidelines, it also requires the knowledge of local guidelines which vary state by state.

"The federal government has authority under the Commerce Clause of the US Constitution to prevent the interstate spread of disease" (Fact Sheet, p.2). The main law federal law governing the use of Isolation/Quarantine is the Public Health Service Act. In Section 264 the Attorney General is given the power to authorize such action with the approval of the Secretary of Health and Human Services. The power is delegated to the CDC by the Attorney General through the Division of Global Migration and Quarantine. The list of communicable diseases is most often amended through executive order made by the president.(Quarantine Q&A, Public Health Services Act) Normally federal and local governments will share the authority. However, if the CDC finds state measures for be insufficient they may step in and take over. Currently non-compliance with an order of quarantine/isolation is a crime punishable by the hefty fine and up to, but no more than, 1 year in prison. Still there are many issues surrounding the Federal Statutes. Because the last time the CDC exercised its power to involuntarily quarantine people was in 1963, there has very little case law to question the legalities of its authority.

Another difficult problem is that most states have different laws and procedures governing the use of Quarantine/Isolation. For this paper, I will try to simplify this by discussing the rules, laws and regulations of New Jersey. Currently on the books is NJSA 26:4-2, which more specifically focuses on the SARS outbreak. This statute states that the NJDHSS (New Jersey State Department of Health and Senior Services) and local boards of health can not only declare what diseases are communicable, declare epidemics and require reporting of communicable diseases, but can also enforce quarantine/isolation wherever deemed necessary. Normally, in the case that a subject refused to adhere to the quarantine/isolation the NJDHSS commissioner, in conjunction with the local public health officer, will issue and administrative order for the action.