Police powers can be invoked to fight illness.

Byline: Tim Christie The Register-Guard

When personal freedom and community health collide, public health officials have broad authority to do what's necessary to stop the spread of disease.

That can mean using their police powers to detain an infectious person until he is no longer contagious. More often, they use persuasion to get someone to stay home until the threat of infection has passed. Most of the time, people cooperate.

But as illustrated by the case of Andrew Speaker, the Atlanta lawyer who traveled the world with an extremely drug-resistant form of tuberculosis, sometimes words aren't enough. Speaker says public health officials told him they preferred he not travel to Europe, but they didn't insist. Public health officials said they told Speaker he was not "highly contagious," but that he should not travel.

Closer to home, Lane County public health officials were stunned last week by the actions of a young Eugene man whom they had diagnosed with measles on May 29. They urged the man to stay home until he was no longer ill, and he agreed, they said.

But that that very night, the man decided to catch a hip-hop show at the WOW Hall, which was crowded with 300 fans. Afterward he hit Jameson's, a downtown bar, staying until closing. The next night, he went out for sushi.

"What was challenging in that circumstance is the person told us they would voluntarily isolate," said Karen Gaffney, assistant director of Lane County Health and Human Services.

"We had no reason to think we would need to use quarantine powers. ... To a certain extent, we do need to take people at their word."

And, in fact, most people do cooperate when confronted with the prospect of being responsible for the spread of a disease that can cause serious illness and even death.

"Normally, we don't have a lot of problems with this," said Dr. Paul Cieslak, communicable disease manager in the state Public Health division.

"The vast majority of people are generally altruistic."

Public health police powers vary from state to state. In Oregon, public health officials can isolate or quarantine individuals whom they suspect are contagious with an infectious disease and who pose a substantial threat to public health.

If the voluntary route doesn't work, public health officials will ask a judge to order the person to be isolated or quarantined, Cieslak said.

Once or twice a year in Oregon, public health officials seek a court order to quarantine someone who won't voluntarily sequester himself, Cieslak said.

"We have to use the least restrictive means that will do that trick," he said.

Often it means putting the person up in a single-occupancy hotel room with a guard posted outside, he said. It's expensive to keep a person confined to a hospital or to lock him up in jail, and "you don't want to do that with someone who hasn't committed a crime," Cieslak said.

Gaffney said she can't remember the last time Lane County officials obtained such a court order, but just this week they were preparing the paperwork during their measles investigation.

They were trying to contact a man who had been exposed to the illness to check his immune status, but he wasn't returning their telephone calls, Gaffney said.

Finally, after the county got word to the man through voice mail and third parties that he faced involuntary quarantine if he didn't cooperate, he called back and agreed to be tested. He turned out to be immune to measles.

"Our first obligation is to protect the health of the community," she said.

"If he had continued not to cooperate, we would have had to go to court to enforce the isolation and confine that person so they would not expose others in the community."

Though public health officials have broad police powers, they generally try to exercise them with discretion, said Dr. Alan Melnick, associate professor of family medicine at Oregon Health & Sciences University and public health officer for Clark and Skamania counties in Washington.

"One concern is, if you're too restrictive, no one is going to come forward," he said.

"You have to strike a balance between restricting people's movement and getting people to be honest with you and not go underground."

Sometimes that means offering people incentives to cooperate, such as gift certificates, he said. And public health officials have to make sure that someone in quarantine has access to food and medical care.

Health officials' police powers would expand in the event of an emergency, such as an influenza pandemic, he said. In such an event, officials could close schools, cancel sporting events and take other measures to keep people from spreading disease.

Legislation to expand and clarify their authority, House Bill 2185, has passed the Legislature and is awaiting the governor's signature.

Gaffney said the measles investigation has helped remind the community about what public health means in the broadest sense.

"Every individual in the community has a responsibility to keep the larger community safe," she said.