Section of Bill

October 23, 2001 Draft

December 21, 2001

Draft

Comments

Cover Page

Lists NAAG as one of the “collaborating” groups

NAAG is dropped, and “in collaboration with” becomes “to assist

HMMM….

Table of Contents

Lists “Planning for a Public Health Emergency” in Article VII

Lists “Planning for a Public Health Emergency” in Article II

Simply a reordering move

Preamble

Does not include references to Local Governments

Includes references to local government role

Preamble

Adds clause regarding the importance of “modernizing public health”

Reflects concerns made by groups about lack of funding for public health

Article I—Section 103.

“Purposes”

Waters down phrases like “control” and “management” to “protection”

Article I—Section 103.

“Purposes”

Adds language allowing state and local officials specific ability to vaccinate

Article I—Section 104.

“Definitions”

Definition of “contagious disease” includes “animal” and “insect-borne” illness

Animal and Insect references dropped

Article I, Section 104. 

“Definitions”

Definition of “infectious disease” altered to include “other pathogens, including a fungus, bacillus, parasite, protozoan, or virus” in addition to those caused by living organisms.

Article I, Section 104.

“Definitions”

Defines “isolation and quarantine” the same

Defines isolation for infected persons and quarantine for those who might be exposed but are not fully infected.  Also removed term “compulsory”

Article I, Section 104

“Definitions”

Adds a new definition for “organized militia”

Article I, Section 104

“Definitions”

“Public Health Emergency”

Redefines public health emergency and includes illnesses or health conditions caused by chemical attacks or accidental releases and nuclear attacks or accidents

Article II, Section 201

“Planning for a Public Health Emergency”

Was Article VII in this draft

Adds a representative of state legislators and the judiciary to the Public Health Emergency Planning Commission

Article II,  Section 201

“Planning for a Public Health Emergency”

Changes review from two years to one year

Article III, Section 301

“Measures to Detect and Track Public Health Emergencies”

(Was Article II in this draft) Requires pharmacists to report unusual symptoms, including “increased numbers of scrips for antibiotics” and “increased number of scrips to treat fever, respiratory, or gastrointestinal complaints”

Removes antibiotic and gastrointestinal language, and replaces with “an unusual increase in the number of prescriptions or over-the-counter pharmaceuticals to treat conditions that the public health authority identifies through regulations”

Seems to be a change for the worse since it will rely on the regulatory process

Article III, Section 301

“Measures to Detect and Track Public Health Emergencies”

Allows for electronic reporting of events and adds the requirement that work addresses be included for reported persons

Article III, Section 303

“Information Sharing”

Requires information sharing “whenever the public health authority learns of a case of a reportable illness or health condition, an unusual cluster, or a suspicious event that it reasonably believes has the potential to be caused by bioterrorism, it must immediately notify the appropriate…authorities”

Deletes references to bioterrorism and replaces with “a suspicious event that may be the cause of a public health emergency”

Article IV, Section 401

“Declaring a state of Public Health Emergency”

Requires the declaration of a state of emergency if a Governor finds an “occurrence or imminent threat” of an illness or health condition, caused by bioterrorism, epidemic or pandemic disease, or novel and highly fatal infectious agents or biological toxins, that poses a significant risk of a substantial number of human fatalities…”

Permits the declaration of a state of emergency upon the occurrence of a “public health emergency” as outlined in the new definitions.  Also adds language directing the gov to consult with the public health authority before such a declaration is made.

Article IV, Section 402

“Content of Declaration”

Specifies content of declaration in new section.  Adds the projected length of duration of the emergency, if less than thirty days, and the primary public health authority responding to the emergency

Article IV, Section 403

“Effect of Declaration”

Adds new provision allowing governor to seek aid from the feds

Article IV, Section 405

“Termination of Declaration”

Requires 2/3 vote of both chambers of a legislature to overturn a declaration, only after its been in effect for sixty days and only upon finding that the “threat” is no longer viable

Requires majority vote of both chambers to overturn a declaration, only after it has been in effect for sixty days and only upon finding the threat is no longer viable

Still prohibits a review of the emergency declaration for 60 days, which is the real problem, not the supermajority requirement.

Article V, Section 502

“Special Powers during a state of Public Health Emergency:  Management of Property”

Adds phrase under (b) regarding the seizure of health care facilities by compelling them to do so “as a condition of licensure, authorization or the ability to continue doing business in the state.”  This phrase used in several other subsections with regard to control of property.

Article V, Section 502

“Access to and Control of facilities and property—generally”

Section (c), “Control of Materials”, adds “to inspect” but deletes “price fixing”, “alcohol, firearms, and explosives”

Article V, Section 504

“Safe disposal of human remains”

Changes “infectious disease” to “contagious disease” and adds phrase requiring sensitivity to cultural/religious traditions under subsection (c).

Article V, Section 504

“Safe disposal of human remains”

Changes “infectious” to “contagious” throughout the section

Article V, Section 505

“Control of Health Care Supplies”

Removes “price fixing” under section (b), “rationing”

Article V, Section 505

“Control of Health Care Supplies”

Adds new section (c) allowing public health authority to give preference to health care providers, disaster personnel, and mortuary staff in rationing or other supply and distribution decisions

What about everyone else?

Article VI,

Section 601

“Special Powers During a State of Public Health Emergency”—Protection of Persons

Old Section 501 titled “control of individuals”

New Section 601 titled “protection of persons”

Reflects softer tone of new bill, moving from “controlling” to “protecting”

Article VI, Section 602

“Medical Examinations and Testing”

Old Section 502 regarding mandatory medical examinations removed but allows for such examinations under new Section 602.  Drops the misdemeanor offense for individuals refusing to submit to such exams.

Article VI, Section 602

“Medical Examinations and Testing”

Old Section 502 (b) dropped regarding misdemeanors for health personnel not willing to perform compulsory exams or tests

Article VI, Section 603

“Vaccination and Treatment”

Old Section 504 compelled vaccinations and made refusal to submit thereto a misdemeanor, as well as subject to possible isolation or quarantine if that person posed a danger to the public health

New Section allows public health authority to vaccinate, drops the misdemeanor, keeps the authority to isolate or quarantine but specifies such measures are designed to prevent the spread of contagious or possibly contagious disease for those who refuse vaccination on health, religious or philosophical grounds.  Drops “danger to public health” qualification for quarantine/isolation

Article VI, Section 603

“Vaccinations and Treatment”

Old Section 504 (b) compelled treatment and made refusal to submit thereto a misdemeanor, as well as subject to possible isolation or quarantine

New Section allows public health authority to treat, drops the misdemeanor, keeps the authority to isolate or quarantine but specifies such measures are designed to prevent the spread of contagious or possibly contagious disease for those who refuse on health, religious or philosophical grounds.  Drops “danger to public health” qualification for quarantine/isolation

Seems worse—now it doesn’t matter if you are a danger to the public health, only if your religion, health status, or other beliefs prevents you from submitting to treatment and/or vaccination

Article VI, Section 604

“Isolation and Quarantine”

Adds new language under (b) providing that quarantine or isolation may take place in a person’s home or private premises

Article VI, Section 604

“Isolation and Quarantine”

Adds new language (b) (2) requiring isolated individuals to be confined separately from quarantined individuals

Reflects new definitions of quarantine and isolation

Article VI, Section 604

“Isolation and Quarantine”

Adds new language under b(4) requiring quarantined individuals who become infected or “reasonably believed to be infected with a contagious or possibly contagious disease” to be removed to isolation

Reflects new definitions of quarantine and isolation

Article VI, Section 604

“Isolation and Quarantine”

Adds new language under (d)(1) describing authorized entry procedures into isolation or quarantine premises

Article VI, Section 605

“Procedures for Isolation and Quarantine”

Old Section 503 outlined due process in terms of “ex parte” orders needed to isolate or quarantine individuals except under certain circumstances

New Section allows quarantine or isolation without notice “through a written directive”

Article VI, Section 605

“Procedures for Isolation and Quarantine”

Old Section 503 did not separate isolation/quarantine “with and without notice”

New section requires the obtaining of a “written petition” from a trial court to authorize isolation or quarantine of an individual or group of individuals and requires that individuals subject to such petition be given 24 hours notice. Outlines procedures for holding a hearing to determine whether quarantine/isolation is to be granted

Article VI, Section 605

“Procedures for Isolation and Quarantine”

Had no time parameters on length of confinement

Adds new language limiting the quarantine/isolation period to 30 days but may be continued via court order

Article VI, Section 605

“Procedures for Isolation and Quarantine”

Adds new Section (c)(1) permitting quarantined individuals to protest the release of another detainee

Article VI, Section 605

“Procedures for Isolation and Quarantine”

Old Section 503 required grievances of detainees to be heard within ten days

Requires grievances to be heard within 24 hours under “extraordinary” circumstances or otherwise five days

Article VI, Section 605

“Procedures for Isolation and Quarantine”

Adds entire new subsection (d) and (e) pertaining to appointment of counsel for those not already represented and for consolidation of claims

Article VI, Section 607

“Access to and disclosure of protected health information”

Old Section 506 allowed for access to records of those in isolation, quarantine, or under the care of the authority

Broadens language to allow access to information of persons who have also been participating in medical testing or vaccination

Article VI, Section 607

“Disclosure”

Required disclosure of PHI to health care personnel and pursuant to an executive order of the Governor

Deletes such requirements