Isolation and Quarantine:Isolation and Quarantine:Illinois’ ApproachIllinois’ Approach

33rdrd Annual Rural Public Health InstituteAnnual Rural Public Health InstituteMarch 1, 2007March 1, 2007

Illinois Department of Public HealthIllinois Department of Public HealthMarilyn Thomas, J.D.Marilyn Thomas, J.D.Chief CounselChief CounselElizabeth Paton, J.D.Elizabeth Paton, J.D.Assistant Chief CounselAssistant Chief Counsel

Isolation and QuarantineIsolation and QuarantineBasis for RegulationsBasis for Regulations

Need for Public Health Legal ToolsNeed for Public Health Legal Tools

Global spread of highly contagious Global spread of highly contagious diseasesdiseasesNew diseases or disease strainsNew diseases or disease strainsBioterrorism preparednessBioterrorism preparedness

⇒⇒ Reassessment of traditional public Reassessment of traditional public health legal authoritieshealth legal authorities

Isolation and QuarantineIsolation and Quarantine

IsolationIsolation:: separation (for a period of separation (for a period of communicability) of communicability) of known infected personsknown infected persons to to prevent transmission of an infectious diseaseprevent transmission of an infectious disease

Quarantine:Quarantine: restriction of activities during restriction of activities during the incubation period of the incubation period of healthy personshealthy personsexposed to a communicable disease to prevent exposed to a communicable disease to prevent transmission transmission ifif infection occursinfection occurs

Key Considerations for Key Considerations for Isolation/QuarantineIsolation/Quarantine

Dangerously contagious and infectious diseaseDangerously contagious and infectious diseaseMedical analysis warrant containmentMedical analysis warrant containmentImplementation and maintenance feasibleImplementation and maintenance feasibleAble to determine who should be containedAble to determine who should be containedResources available to support and enforce Resources available to support and enforce containmentcontainmentCan the person be confined for incubation Can the person be confined for incubation period?period?Potential benefits outweigh possible adverse Potential benefits outweigh possible adverse consequencesconsequences

Isolation & Quarantine Law: BasisIsolation & Quarantine Law: Basis

20 ILCS 2305 20 ILCS 2305 -- Department of Public Health Department of Public Health Act Act

20 ILCS 2310 20 ILCS 2310 –– Department of Public Health Department of Public Health Powers and Duties LawPowers and Duties Law

Administrative RulesAdministrative Rules

Isolation and Quarantine LawIsolation and Quarantine Law

When a person voluntarily complies with When a person voluntarily complies with IDPH recommendations for control of a IDPH recommendations for control of a communicable disease communicable disease ---- No additional No additional intervention is necessaryintervention is necessary

Law/regulations designed to address Law/regulations designed to address situations where voluntary compliance situations where voluntary compliance fails, and are extraordinary measuresfails, and are extraordinary measures

Isolation and Quarantine LawIsolation and Quarantine Law

IDPH’s Current Authority:IDPH’s Current Authority:

Supreme authority in matters of quarantine and Supreme authority in matters of quarantine and isolation.isolation.

General supervision of interests of health and lives of General supervision of interests of health and lives of people of Illinois.people of Illinois.

Broad rulemaking authority for preservation and Broad rulemaking authority for preservation and improvement of the public health.improvement of the public health.

Isolation and Quarantine LawIsolation and Quarantine LawIDPH may delegate its duties to county and multipleIDPH may delegate its duties to county and multiple--county boards of health when IDPH makes the county boards of health when IDPH makes the determination that such delegation is necessary.determination that such delegation is necessary.

All local boards of health, health authorities and All local boards of health, health authorities and officers, police officers, and employees of the state or officers, police officers, and employees of the state or any locality to enforce orders issued by IDPH.any locality to enforce orders issued by IDPH.

Violation of IDPH orders constitutes a Class A Violation of IDPH orders constitutes a Class A misdemeanor.misdemeanor.

Isolation and Quarantine LawIsolation and Quarantine Law

Issue immediate orders for isolation and Issue immediate orders for isolation and quarantinequarantine

Without prior consent or court orderWithout prior consent or court order

When in reasonable judgment of IDPH immediate action is When in reasonable judgment of IDPH immediate action is required to protect the public from a dangerously contagious required to protect the public from a dangerously contagious or infectious disease.or infectious disease.

As soon as practicable, within 48 hours after issuing order, As soon as practicable, within 48 hours after issuing order, IDPH must:IDPH must:

Obtain consent; orObtain consent; orFile a petition requesting a court orderFile a petition requesting a court order

Other Related Powers: Other Related Powers: Orders for physical examination, testing, collection of Orders for physical examination, testing, collection of laboratory specimens, vaccinations, medications, laboratory specimens, vaccinations, medications, other treatments, & observation & monitoring.other treatments, & observation & monitoring.

Individual has right to refuse to consent.Individual has right to refuse to consent.If refuses, and uncertainty re: whether exposed or If refuses, and uncertainty re: whether exposed or infected, individual may be subject to isolation or infected, individual may be subject to isolation or quarantine.quarantine.

Right to counsel if subject to isolation or quarantineRight to counsel if subject to isolation or quarantine

Due ProcessDue Process

All legal procedures set by statute and court All legal procedures set by statute and court practice, including notice of rights, must be practice, including notice of rights, must be followed for each individual so that no followed for each individual so that no prejudicial or unequal treatment will result. prejudicial or unequal treatment will result. The universal guarantee of due process is in the The universal guarantee of due process is in the Fifth Amendment to the U.S. Constitution, which Fifth Amendment to the U.S. Constitution, which provides "No person shall…be deprived of life, provides "No person shall…be deprived of life, liberty, or property, without due process of law," liberty, or property, without due process of law," and is applied to all states by the 14th and is applied to all states by the 14th Amendment. Amendment.

Isolation and QuarantineIsolation and QuarantineAdministrative RulesAdministrative Rules

Isolation and Quarantine RulesIsolation and Quarantine Rules

Part of the Communicable Disease Code, Part of the Communicable Disease Code, 77 Ill. Adm. Code 69077 Ill. Adm. Code 690

New Subpart H: Isolation, Quarantine and New Subpart H: Isolation, Quarantine and ClosureClosure

Isolation and Quarantine RulesIsolation and Quarantine RulesIssues Rules Address:Issues Rules Address:

Delegation to Local Health AuthoritiesDelegation to Local Health AuthoritiesInvestigation and EnforcementInvestigation and EnforcementNoticeNoticeVoluntary v. InvoluntaryVoluntary v. InvoluntaryRight to CounselRight to CounselLeast Restrictive Means: tied to particular Least Restrictive Means: tied to particular circumstances, have scientific basiscircumstances, have scientific basisOrders and Procedures for isolation, Orders and Procedures for isolation, quarantine and closurequarantine and closure

DelegationDelegation

Explicit delegation of Department’s powers to Explicit delegation of Department’s powers to issue orders and to issue and enforce orderissue orders and to issue and enforce order

Delegation to county and multipleDelegation to county and multiple--county boards county boards of Health only per Powers and Duties Law of Health only per Powers and Duties Law authorityauthority

Department will work jointly with municipal local Department will work jointly with municipal local health authorities to institute and implement health authorities to institute and implement isolation, quarantine and closuresisolation, quarantine and closures

Responsibilities and Duties of LHDResponsibilities and Duties of LHD

Work in coordination with the DepartmentWork in coordination with the Department

Authority to investigate and institute disease Authority to investigate and institute disease control measurescontrol measures

Responsible for surveillance and investigation of Responsible for surveillance and investigation of diseases within their jurisdictiondiseases within their jurisdiction

Consult with Department to identify the least Consult with Department to identify the least restrictive means of controlling the diseaserestrictive means of controlling the disease

Responsibilities & Duties of LHDResponsibilities & Duties of LHD

Notify the Department telephonically within 3 Notify the Department telephonically within 3 hours after issuance of an order for isolation, hours after issuance of an order for isolation, quarantine or closurequarantine or closure

In consultation with community partners, In consultation with community partners, establish plans, policies and procedures for establish plans, policies and procedures for instituting and maintaining health measuresinstituting and maintaining health measures

Notify health care providers about rulesNotify health care providers about rules

IDPH AuthorityIDPH Authority

Department may rescind any order issued Department may rescind any order issued by local heath authority when necessaryby local heath authority when necessary

Local health authority may not alter any of Local health authority may not alter any of the orders issued by the Department the orders issued by the Department without Department’s express permissionwithout Department’s express permission

InvestigationsInvestigations

Department or LHD shall conduct Department or LHD shall conduct investigations to confirm the diagnosis, investigations to confirm the diagnosis, treatment and causes of dangerously treatment and causes of dangerously contagious and infectious diseasescontagious and infectious diseases

Review of relevant medical recordsReview of relevant medical recordsInterviewsInterviewsMedical examinationsMedical examinationsCollect environmental samplesCollect environmental samplesEntering a place of employment to conduct Entering a place of employment to conduct investigationsinvestigations

Conditions and PrinciplesConditions and Principles

By least restrictive means necessary to prevent By least restrictive means necessary to prevent spread of diseasespread of diseaseHealth status of affected persons to be Health status of affected persons to be monitored regularlymonitored regularlyReleased as soon as no longer a threatReleased as soon as no longer a threatCultural and religious beliefs should be Cultural and religious beliefs should be considered considered Notice provided to reasonable number of Notice provided to reasonable number of persons that an individual is subject to an order persons that an individual is subject to an order

Order and ProcedureOrder and Procedure

May issue Order for isolation, quarantine or May issue Order for isolation, quarantine or closure on immediate basis without prior closure on immediate basis without prior consent or court order consent or court order

Must first make documented efforts to obtain Must first make documented efforts to obtain voluntary compliancevoluntary compliance

Immediate order not to exceed period of Immediate order not to exceed period of incubationincubation

Verbal OrdersVerbal Orders

Verbal order may be issued if the delay in Verbal order may be issued if the delay in imposing written order would jeopardize the imposing written order would jeopardize the ability to prevent transmissionability to prevent transmission

Valid for 24 hours and followed up with a Valid for 24 hours and followed up with a written orderwritten order

Continued beyond initial 24 hour period only if Continued beyond initial 24 hour period only if written order issued.written order issued.

Isolation and Quarantine RulesIsolation and Quarantine Rules

Prior to issuing an order for Isolation, Prior to issuing an order for Isolation, Quarantine or Closure, an attempt must Quarantine or Closure, an attempt must be made for voluntary compliance. be made for voluntary compliance.

Documentation is very important Documentation is very important

Powers of law enforcement may be Powers of law enforcement may be requested in order to enforce a public requested in order to enforce a public health order for Isolation, Quarantine or health order for Isolation, Quarantine or Closure.Closure.

Written Order RequirementsWritten Order Requirements

Identity of personsIdentity of personsPremises Premises Notice of right to counselNotice of right to counselIf indigent, counsel will be appointedIf indigent, counsel will be appointedReason for Isolation, Quarantine or ClosureReason for Isolation, Quarantine or ClosureAnticipated durationAnticipated durationHow attempted to obtain voluntary complianceHow attempted to obtain voluntary complianceMedical basis on which order is justifiedMedical basis on which order is justified

Court Order PetitionCourt Order Petition

Petition for Court Orders:Petition for Court Orders:File petition with court within 48 hours File petition with court within 48 hours Petition must include same items as detention Petition must include same items as detention orderorderInclude attestation Include attestation Be served of notice of hearing at least 24 Be served of notice of hearing at least 24 hours before the court hearinghours before the court hearing

Isolation or Quarantine PremisesIsolation or Quarantine Premises

Health care providers allowed access to Health care providers allowed access to meet needsmeet needs

Sites to be prominently placarded with Sites to be prominently placarded with signssigns

Persons who enter premises may Persons who enter premises may themselves be subject to isolation or themselves be subject to isolation or quarantinequarantine

Isolation and Quarantine RulesIsolation and Quarantine Rules

Additional Provisions:Additional Provisions:Relief from DetentionRelief from DetentionService of Department OrderService of Department OrderPhysical Exam, Testing, Lab SpecimensPhysical Exam, Testing, Lab SpecimensVaccines, Medications & Other TreatmentsVaccines, Medications & Other TreatmentsObservation & MonitoringObservation & MonitoringPenaltiesPenalties

SummarySummary

Isolation and quarantine only one aspect Isolation and quarantine only one aspect of communicable disease controlof communicable disease controlVoluntary compliance with isolation and Voluntary compliance with isolation and quarantine is extremely importantquarantine is extremely importantIllinois law recently updated to address Illinois law recently updated to address legal and procedural concerns with legal and procedural concerns with involuntary isolation and quarantineinvoluntary isolation and quarantineCollaboration with our partners in local Collaboration with our partners in local jurisdictions is KEYjurisdictions is KEY

Disaster PrivilegesDisaster PrivilegesAdministrative RulesAdministrative Rules

Disaster Privileges RulesDisaster Privileges RulesAmends Hospital Licensing Requirements, 77 Ill. Adm. Amends Hospital Licensing Requirements, 77 Ill. Adm. Code 250Code 250

Amends Subpart C: The Medical StaffAmends Subpart C: The Medical Staff

Hospitals would be required to establish a procedure for Hospitals would be required to establish a procedure for granting disaster privileges.granting disaster privileges.

The procedure would be used when the emergency The procedure would be used when the emergency management plan has been activated and the hospital is management plan has been activated and the hospital is unable to handle the immediate needs of the patients.unable to handle the immediate needs of the patients.

Disaster Privileges ProcedureDisaster Privileges Procedure

The procedure for granting disaster The procedure for granting disaster privileges shall include:privileges shall include:

Identifying in writing the individual(s) Identifying in writing the individual(s) responsible for granting disaster privileges responsible for granting disaster privileges andandDescribe in writing the responsibilities of the Describe in writing the responsibilities of the individual(s) granting disaster privileges.individual(s) granting disaster privileges.

The responsible individual is not required to grant The responsible individual is not required to grant disaster privileges anddisaster privileges andThe responsible individual is expected to make The responsible individual is expected to make decisions on a casedecisions on a case--byby--case basis at his or her case basis at his or her discretion.discretion.

Disaster Privileges ProcedureDisaster Privileges ProcedureThe procedure shall also describe in writing a The procedure shall also describe in writing a mechanism to manage individuals who receive disaster mechanism to manage individuals who receive disaster privileges andprivileges and

Include a mechanism to allow staff to readily identify Include a mechanism to allow staff to readily identify individuals who receive disaster privileges andindividuals who receive disaster privileges and

Require that medical staff address the verification of Require that medical staff address the verification of credentials process as a high priority and begin the credentials process as a high priority and begin the verification process as soon as the immediate situation is verification process as soon as the immediate situation is under control.under control.

The individual(s) responsible for granting disaster The individual(s) responsible for granting disaster privileges may grant privileges upon presentation of privileges may grant privileges upon presentation of various forms of identification listed in the rule.various forms of identification listed in the rule.

Disaster Privileges RulesDisaster Privileges RulesAny hospital and/or any employee involved in Any hospital and/or any employee involved in the granting of disaster privileges that, in good the granting of disaster privileges that, in good faith, grants disaster privilege shall not, as a faith, grants disaster privilege shall not, as a result of acts or omissions, be liable for civil result of acts or omissions, be liable for civil damages except in the event of willful and damages except in the event of willful and wanton misconduct.wanton misconduct.

Individuals granted disaster privileges who Individuals granted disaster privileges who provide care, in good faith and without direct provide care, in good faith and without direct compensation, shall not as a result of or compensation, shall not as a result of or omissions except for willful and wanton omissions except for willful and wanton misconduct be liable for civil damages.misconduct be liable for civil damages.

Isolation and QuarantineIsolation and QuarantineDisaster PrivilegeDisaster Privilege

RulesRules

Next StepsNext Steps

Rulemaking ProcessRulemaking Process

Internal ProcessInternal ProcessRule presented to State Board of Health for review and Rule presented to State Board of Health for review and comments. Comments and changes are discussed and comments. Comments and changes are discussed and incorporated.incorporated.Rule prepared for publication and filed with Secretary Rule prepared for publication and filed with Secretary of State (starts First Notice period)of State (starts First Notice period)

External ProcessExternal ProcessFiled with Secretary of StateFiled with Secretary of StatePublished in Published in Illinois RegisterIllinois Register for 45for 45--day minimum day minimum comment periodcomment periodIDPH reviews comments received and may make IDPH reviews comments received and may make changeschanges

Rulemaking ProcessRulemaking Process

Second Notice PeriodSecond Notice PeriodIDPH submits Second Notice to Joint IDPH submits Second Notice to Joint Commission on Administrative Rules (JCAR)Commission on Administrative Rules (JCAR)Last maximum 45 days, unless extended by Last maximum 45 days, unless extended by mutual agreement with JCARmutual agreement with JCARJCAR reviews proposed rule during this periodJCAR reviews proposed rule during this periodJCAR notifies IDPH of date of Second Notice JCAR notifies IDPH of date of Second Notice and date of JCAR meetingand date of JCAR meeting

Rulemaking ProcessRulemaking Process

JCAR can then:JCAR can then:Issue Certificate of No Objection and provide Issue Certificate of No Objection and provide changes orchanges orIssue Objection, Recommendation or Filing Issue Objection, Recommendation or Filing Prohibition.Prohibition.

If JCAR issues No Objection then:If JCAR issues No Objection then:IPDH prepares final filing and files adopted IPDH prepares final filing and files adopted rule with Secretary of State (effective at time rule with Secretary of State (effective at time of filing)of filing)Final Rulemaking published in Final Rulemaking published in Illinois RegisterIllinois Register

QUESTIONSQUESTIONS

Contact InformationContact Information

Marilyn Thomas, J.D.Marilyn Thomas, J.D.Illinois Department of Public HealthIllinois Department of Public Health535 W. Jefferson St.535 W. Jefferson St.Springfield, IL 62761Springfield, IL 62761(312) 814(312) 814--11001100Marilyn.Thomas@Illinois.govMarilyn.Thomas@Illinois.gov

Contact InformationContact InformationElizabeth Paton, J.D.Elizabeth Paton, J.D.Illinois Department of Public Health Illinois Department of Public Health 535 W. Jefferson St.535 W. Jefferson St.Springfield, IL 62761Springfield, IL 62761217217--782782--20432043Elizabeth.Paton@Illinois.govElizabeth.Paton@Illinois.gov