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Act outlines ways to protect health care workers and the public in an emergency. (Health Policy Update).

The events of September 11th brought a new level of interest in the role of public health in national defense.

One important component of this new role is the legal framework for public health powers needed to control epidemics and reduce the morbidity associated with disasters.

In most states, the police powers of public health laws have not been updated for several years and may not represent the authorities' needs in a catastrophic health emergency.

Recently, a national effort got under way to encourage the modernization of public health authorities. Many states are debating these powers as they review state security concerns.

The model act

The Model State Emergency Powers Act is a sample law designed to define the powers public health officials need during a public health emergency.

The act was crafted for the U.S. Centers for Disease Control and Prevention (CDC) by the Center for Law and the Public's Health at the Georgetown and Johns Hopkins universities.

While defined as a "model act" the document is really a blueprint of the kinds of authorities needed in an emergency.

It covers a broad range of areas of interest to public health officials such as:

* Plan development

* Surveillance for the early detection of a public health emergency

* Disease reporting

* Authority for disease containment to include isolation and quarantine

* Authority to provide for medical care

* Property rights, should officials use and appropriate property

The details

The act would require each state or territory to develop a plan to address an emergency and defines a broad range of components to be included in the plan.

Most states will be doing this type of planning even without this kind of legislation because recent funding from the CDC requires a similar plan to receive public health preparedness funding.

The act defines the reporting requirements for reportable diseases for health care providers, medical examiners or coroners, pharmacists and veterinarians. The act also allows for the tracking of diseases and the sharing of confidential information with appropriate authorities.

It has a section that focuses on the process for declaring an emergency and outlines the roles of the governor and public health authority.

The act recommends that the governor declare an emergency after consulting with the public health authority. It also recommends that the emergency be declared in writing as an executive order and specify the nature of the emergency, its location, duration and who is the responsible public health official.

In most states during an emergency, the governor's authority is quite broad. It allows the governor to:

* Utilize all state or local resources

* Transfer or direct all functions or personnel of state government

* Mobilize the state militia

* Seek aid from the federal government or other

* Suspend all statutory laws

The model law confirms the need for these powers. It also recommends that public health authorities have the power during a declared emergency to use public safety officials to help enforce orders issued under this declaration.

The act also defines the process to terminate the emergency declaration. Under the proposed act, the declaration expires after 30 days, unless renewed. There is also a provision to allow the state legislature to terminate the declaration.

The act grants authority to close, evacuate or decontaminate any facility that may endanger the public. This includes the destruction of materials believed to be dangerous to the public's health.

This power includes the ability to require the use of a health care facility to provide services. It also allows for the authority to procure or take any emergency action necessary to respond to the crisis. In some situations this may include the lawful taking of property. It requires that the owner receive just compensation for their loss.

This does not include reimbursement for facilities that are closed, evacuated, destroyed or decontaminated if there is a reasonable belief that there is harm to the public. There is a provision for appropriate civil proceedings prior to the destruction of property.

The safe disposal of infectious waste and human remains is also accounted for.

Clinical protections

There are strong provisions to allow health authorities to examine and test people for disease and offer a broad range of treatments, including vaccination. It also defines the need to limit access to and disclosure of protected health information.

The role of quarantine and isolation as disease control measures are defined clearly. The act also defines the rights persons have while contained, the legal process to appeal and the right to legal counsel. The quarantine must be by written directive. The written directive must include the:

* Identity of the individuals

* Location of the premises

* Name of the known or suspected contagious disease

* Date and time quarantine is to start

It allows for credentialling of health care providers and ensures that providers responding under the authority of state or local authorities are immune from liability except in the case of gross negligence or willful misconduct.

States react

In most states, the public health authorities already have a broad range of powers to identify, contain and require the reporting of disease.

It is essential that states carefully review their existing powers to ensure that they are not weakening or eliminating existing authority prior to enacting components of the model act.

It is also important that these authorities be clarified now, prior to a disaster. Debate over legal authority could delay public health action that might increase the risk of death or disability.

The act represents an attempt to modernize public health authorities to address a public health emergency. It is designed as a template for states to measure their current public health authorities.

Physician leadership is essential to make certain that these powers are properly crafted to ensure the public's health while preserving civil liberties.

Resources

(1.) Gostin, L and Teret, S. The Model State Emergency Health Powers Act, The center for Law and the Public's Health, Georgetown University/Johns Hopkins University, 2001.

(2.) HYPERLINK http://www.publichealthlaw.net www.publichealthlaw.net (current as of 3/27/2002)

Georges Benjamin, MD, FACP, is the Secretary of the Department of Health and Mental Hygiene in Baltimore, Md. He can be reached by calling 410/767-6505 or by e-mail at benjaming@airbridge.net
COPYRIGHT 2002 American College of Physician Executives
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Author:Benjamin, Georges C.
Publication:Physician Executive
Geographic Code:1USA
Date:May 1, 2002
Words:1030
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