Quarantine and Isolation Authorities in States Affected by COVID-19
Every state has reported cases of coronavirus infection. But what power do these states have to order compulsory quarantine of infected or exposed persons?
Published by The Lawfare Institute
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Editor's note: Lawfare has also compiled an overview of state emergency authorities available to governors in responding to the pandemic. You can read that overview here.
On Jan. 21, the United States reported its first case of coronavirus infection. Since that confirmed first case in Washington state, the virus has spread to all 50 states, the District of Columbia and multiple territories, infecting more than 234,000 people in the United States. As the virus continues to spread, we have also started to see stories of exposed persons violating recommended self-quarantines. In New Hampshire, a patient who became the state’s first confirmed case ignored medical advice and attended an event at a crowded music venue. He was then ordered by the state’s health commissioner to isolate at home. In Missouri, two schools closed temporarily after close relatives of the state’s first coronavirus patient attended a dance with students, also in violation of instructions to self-quarantine at home. In Kentucky, a patient who had tested positive for the coronavirus checked himself out of the hospital against medical advice and refused to quarantine himself. Law enforcement surrounded his house to prevent him from leaving and spreading the virus. So what powers do these states have to order compulsory quarantine of infected or exposed persons? Below, we provide a review of relevant state law authorizing quarantine or isolation. The summaries for each state and inhabited U.S. territory are listed in alphabetical order.
Alabama, Alaska, American Samoa, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Guam, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Northern Mariana Islands, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, U.S. Virgin Islands, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming
A list of relevant statutory authority for all states is also available on the National Conference of State Legislatures (NCSL) website. The NCSL also provides the following definitions for quarantine and isolation:
Quarantine: Compulsory separation, including restriction of movement, of people who potentially have been exposed to a contagious disease, until it can be determined whether they have become sick or no longer pose a risk to others. This determination could be made, for example, based on the time elapsed from their potential exposure.
Isolation: Separation of people known or suspected (via signs, symptoms or laboratory criteria) to be infected with a contagious disease from those who are not sick to prevent them from transmitting the disease to others.
Alabama state law code Sections 22-12-1 to 22-12-29 give the governor or the State Board of Health the power to “proclaim a quarantine.” Once a quarantine is declared, the governor, the State Board of Health, county boards of health and municipal boards of health all have the power to enforce a quarantine through any necessary rules or regulations. However, Section 22-12-2 ensures that “the quarantine authority of the state shall be paramount to that of any county, city or town therein.”
Even though the state of Alabama has final authority over county and municipal boards of health, Sections 22-12-14, 22-12-12, 22-12-13 and 22-3-2 give county and municipal boards a significant amount of discretion to obtain and enforce quarantines.
When a contagious or infectious disease exists in a part of a county or municipality, Section 22-12-14 allows that county or municipality’s board of health to establish a quarantine. Under Section 22-12-12, a quarantine is established when a county or municipal board of health recommends a quarantine, the State Board of Health approves the recommendation and a probate judge in that county proclaims it. Section 22-12-12 also gives a county or municipality’s mayor or chief executive officer the power to declare an emergency quarantine. But an emergency declaration is subject to approval, modification or withdrawal by that county or municipality’s board of health as well as the State Board of Health. Additionally, Section 22-12-17 requires that the local authorities responsible for declaring a quarantine report their actions to the State Board of Health.
Once a quarantine is declared in part of a county or municipality, Sections 22-12-13 and 22-12-15 entrust a quarantine’s enforcement to the municipal or county health officer. Section 22-3-2 outlines the health officer’s expected duties. They include supervising the enforcement of the health laws of the state; promulgating rules and regulations for administering the health laws of the state and the rules and regulations of the State Board of Health; investigating cases or outbreaks of any enumerated diseases; and enforcing such measures for the prevention or extermination of said diseases as are authorized by law.
To fulfill these duties, Section 22-12-18 gives these officers the ability to restrain any individual exiting a quarantined area from further travel and Section 22-12-26 expands these powers by giving any legal quarantine officer or guard the ability to conduct a warrantless arrest if an individual is attempting to violate a quarantine regulation. Section 22-12-19 also gives the municipal or county health officer the power to establish a place of detention in their municipality or county to detain individuals who attempt to leave a quarantined area. Additionally, Section 22-12-21 places the supervision of trains, buses, aircraft and watercraft affected by a quarantine under the supervision of the State Board of Health and the quarantine authorities of the relevant county, city, or town. Section 22-12-22 further disincentivizes third parties from knowingly helping others leave a quarantined zone by designating this action a misdemeanor offense that carries fine between $100 and $500.
But Alabama laws also give citizens the ability to petition their respective quarantine authorities for release. Section 22-12-29 allows any person prevented from leaving or entering a location by a quarantine officer or guard to make an affidavit presenting evidence that they have not been in any quarantined location. If this affidavit meets the standards set by the State Board of Health, that individual must be allowed to enter or leave their indicated location. This same section also provides that any person placed under quarantine may make an affidavit showing they have complied with the detention and disinfection requirements and should be released. If this affidavit meets the State Board of Health’s requirements, then that individual cannot be held. Section 22-12-29 adds that any quarantine officer or guard who violates these requirements can be guilty of a misdemeanor offense and fined between $50 and $100.
Under Section 26.23.020(b) of Alaska’s Disaster Act, the governor can issue orders, proclamations and regulations with the force of law necessary to reduce Alaskan citizens’ vulnerability to damage, injury, and loss of life and property resulting from “a disaster.” Section 26.23.900(2) of this act contains five definitions of “a disaster.” One of these definitions is “an outbreak of disease or a credible threat of an imminent outbreak of disease that the commissioner of health and social services or a designee of the commissioner of health and social services certifies to the governor has a high probability of occurring in the near future.”
Section 26.23.020 of Alaska’s Disaster Act allows the governor to invoke his or her emergency powers by proclaiming “a disaster” has occurred or is imminent. This proclamation “activates the disaster response and recovery aspects of the state, local, and interjurisdictional disaster emergency plans applicable to the political subdivisions or areas in question.” However, the governor’s power to declare an emergency is limited by Section 26.23.025(c), which reserves the Alaskan legislature’s power to pass a law ending any disaster emergency.
During a disaster the governor “is commander in chief of the organized and unorganized militia and of all other forces available for emergency duty.” Section 26.23.020(g)’s subsections also give the governor broad powers, including the ability to:
Suspend the provisions of any regulatory statute prescribing procedures for the conduct of state business, or the orders or regulations of any state agency, if compliance would prevent, or substantially impede necessary actions to alleviate the disaster;
use all available resources of the state government and of each political subdivision of the state as reasonably necessary to cope with the disaster emergency;
commandeer or utilize any private property, except as limited by the act;
direct and compel the relocation of all or part of the population from any stricken or threatened area in the state;
prescribe routes, modes of transportation, and destinations in connection with necessary relocation; and,
control ingress to and egress from a disaster area, the movement of persons within the area, and the occupancy of premises in it.
Once the governor declares a disaster emergency due to an outbreak of disease or a credible threat of an imminent outbreak, Alaska’s public health law Section 18.15.390 also gives the state Department of Health an additional set of emergency powers. These powers include:
completing the evacuation or decontaminate of any facility that may endanger the public health;
controlling and regulating, the use, sale, distribution, or transportation of commodities, as may be reasonable and necessary to respond to the disaster;
the ability to adopt and enforce measures to provide for the safe disposal of infectious waste or emergency appointment made under this paragraph for any reason.
In addition to these emergency powers, Section 18.15.385 of Alaska’s public health law gives state officials the ability to quarantine individuals or groups if doing so is “the least restrictive alternative necessary to prevent the spread of a contagious or possibly contagious disease to others.” However, Section 18.15.385(b) places significant restrictions on how and when this ability can be used.
To start, Section 18.15.385(d) requires the Department of Health to “obtain a written order from the superior court authorizing the quarantine, unless the individual consents to the quarantine.” This petition must disclose the identity of the person (or persons) to be quarantined, the premises where the quarantine will occur, the date the quarantine starts, the suspected disease, and a showing that the person (or persons) poses a risk to public health and is unwilling to behave so as not to expose other individuals to danger of infection. However, if the Department of Health has probable cause to believe that the delay involved in seeking a court order imposing quarantine would pose a clear and immediate threat to the public health and quarantine is the least restrictive alternative and is necessary to prevent the spread of a contagious contagious disease, then a state medical officer in the department may issue an emergency administrative order to temporarily quarantine an individual or group of individuals.
If a quarantine occurs, Section 18.15.385(b)(2) of the same act requires the Department of Health to quarantine a person in his or her own home unless there are exceptional circumstances. Sections 18.15.385(b)(3) and (5) also mandate that the Department of Health regularly monitor quarantined individuals to determine whether the quarantine remains necessary and immediately terminate a quarantine order when an individual or group poses no substantial risk of transmitting a contagious disease to others.
If the Department of Health issued an emergency administrative quarantine order, Section 18.15.385(f) gives the individual or persons listed in that order the right to a court hearing within 48 hours. If the Department of Health can show good cause, a court may postpone the hearing for up to five days. At the conclusion of the hearing, Section 18.15.385(h) allows the court to commit the individual or individuals to quarantine for not more than 30 days if the court finds, by clear and convincing evidence, that the isolation or quarantine is necessary to prevent or limit the transmission of a disease that poses a significant risk to the public health. Under Section 18.15.385(i), before the expiration of the order described in Section 18.15.385(h), the court may continue the quarantine for additional periods not exceeding 30 days upon a showing by the department, by clear and convincing evidence, that the action is still necessary to prevent or limit the transmission to others of a disease.
“Knowingly” violating a quarantine order is a Class B misdemeanor, punishable by up to 90 days in jail and a maximum fine of $2,000. Additionally, “intentionally” violating a quarantine order is a Class A misdemeanor, punishable by up to one year in jail and a fine of up to $10,000. Under Alaskan law Section 11.81.900, individuals “knowingly” violate an order when they are aware of a substantial probability that they are violating a law or their conduct is of a nature that might violate a law. Individuals “intentionally” violate an order when they are consciously aware that breaking quarantine is against the law.
American Samoa Public Health Act (Public Law No. 30 of 2007) regulates the public health of American Samoa and aims to strengthen the public health infrastructure of the territory. Under Section 13.0206, the Department of Health has the power to declare and enforce quarantine, to prevent, limit or modify attendance at school in the event of an imminent epidemic or serious outbreak of communicable disease and take precautionary measures such as embargoes, detention and removal of products; declaration of quarantine; provision of public health information and messaging; and promotion of efforts to detect and ameliorate disease.
Section 13.0209 and 13.0210 require the director of the Department of Health to establish a list of reportable diseases and conditions of public health importance, to distribute the list and to require every health care provider, physician, pharmacist, laboratory director, coroner, medical examiner and veterinarian with knowledge of a case of such a disease or condition to report the incident to the Department of Health in writing within a specified time period. Failure of these officials to report a required disease or condition within the specified time period is a Class A misdemeanor under Section 13.0211.
If the department receives a complaint or has reasonable belief supported by sufficient facts that a condition of public health importance exists, then the department may inspect and investigate under Section 13.0212. Under Section 13.0213, this may include methods of epidemiological investigation, including identifying individuals who may have been exposed or infected, interviewing and testing these individuals, and examining facilities or materials that may pose a public health threat. It may also include investigating potential sources of exposure and infection and ensuring proper control measures. The department may also close, evacuate or decontaminate any facility or destroy or decontaminate any material “when it reasonably believes that such facility or material may endanger investigators, other individuals, or the public's health.”
Section 13.0214 empowers the department to compel medical treatment, defined as “an appropriately prescribed course of medication,” for individuals who were or may have been exposed to a contagious disease posing significant risk to public health. The treatment must be “reasonably calculated to prevent, control, or ameliorate” the condition and the department personnel who examines or treats the person must instruct them about measures to prevent reinfection and disease transmission.
The director, or his or her designee, may order isolation or quarantine of an individual or group under Section 13.0215. The isolation or quarantine order must be the least restrictive means necessary to prevent spread of the disease and may include confinement to a private home or other private or public premises. The health status of the confined person must be regularly monitored to determine if continued confinement is necessary and the isolation or quarantine must be immediately terminated if the person no longer poses a substantial risk of transmitting a contagious disease to others.
While in quarantine or isolation, the needs of the confined individual must be addressed in a “systematic and competent fashion,” including providing adequate food, clothing, shelter, means of communication and competent medical care. In addressing these needs and establishing and maintaining the isolation or quarantine premises, the person’s cultural and religious beliefs are to be respected to the extent possible. The department may authorize access to the premises where necessary to meet the confined person’s needs, including medical care.
An isolation or quarantine order can be initiated on a temporary basis without notice under Section 13.0215(d). The director may issue such an order by written directive if delay in imposing the confinement would “significantly jeopardize the department’s ability to prevent or limit the transmission” of a contagious disease. The directive must specify the identity of the person, the premises, date and time and suspected contagious disease and a copy of the directive must be given to the individual or, if the directive applies to a group of individuals and individual delivery is impracticable, posted in a conspicuous place in the premises. Within 10 days of issuing a written directive for temporary isolation or quarantine, the director must petition for a court order authorizing continued isolation or quarantine.
Under Section 13.0215(e) the director may petition a court for an order authorizing isolation or quarantine. The petition must specify the identity of the person, the premises, date and time, the suspected contagious disease, a statement of compliance with the conditions and principles of isolation and quarantine, and a statement of the basis justifying the isolation or quarantine. The petition must be accompanied by a sworn affidavit by the director, or designee, attesting to the facts asserted in the petition; and notice must be given to the affected individuals. A hearing will be held on the petition as soon as practical after the petition is filed, but in extraordinary circumstances and for good cause the director may apply to continue the hearing for up to five days. The court shall grant the petition if isolation or quarantine is shown by clear and convincing evidence to be reasonably necessary to prevent or limit the transmission of the disease.
An order authorizing isolation or quarantine may not exceed 30 days unless continued by court order. For an order continuing the confinement for up to an additional 30 days, the director must move for such an order prior to the expiration of the isolation or quarantine. Such an order must identify the person, specify factual findings warranting the isolation or quarantine, and include any conditions necessary to ensure the isolation or quarantine is carried out within the statutory purposes and restrictions.
An isolated or quarantined person may apply to the court under Section 13.0215(g) for an order to show cause why isolation or quarantine should not be terminated. The court is to rule on the application as soon as practicable, but the director may move for an extension of time based on extraordinary circumstances. The court may not enjoin or stay an isolation or quarantine order. The court may grant a hearing for remedies regarding breaches of the conditions of isolation or quarantine.
Arizona provides a general process of quarantine for any contagious or infectious disease and more specific process in the case of a declared state of emergency.
Any person aware of a case of contagious, epidemic or infectious disease must immediately report the name and location of the person to the board of health or health department. Knowingly withholding such information by any person or other violations of these provisions or of a rule, regulation, order, instruction or measure adopted pursuant to them constitutes a Class 3 misdemeanor. It is a Class 2 misdemeanor to knowingly expose oneself or another infected person in a public place, except if necessary to remove the person.
Upon notification of the existence of a contagious or infectious disease in its jurisdiction, the county health department or public health services district must investigate immediately and, if the disease is confirmed, immediately inform the state’s Department of Health Services and adopt quarantine or sanitary measures to prevent transmission of the disease. The local board of health and health department have authority to take control of any hospitals or other facilities where infectious or contagious disease exists or to provide temporary hospitals or facilities to receive infected persons. Arizona also provides for the disinfection or destruction of any contaminated property or articles and for reasonable compensation for such destruction.
Arizona provides further quarantine and isolation instruction in the event of a declared public health emergency. The governor may issue an “enhanced surveillance advisory” upon reasonable cause to believe that “an illness, health condition or clinical syndrome caused by bioterrorism, epidemic or pandemic disease or a highly fatal and highly infectious agent or biological toxin has or may occur.” The governor is to consider the least restrictive measures necessary, consistent with public health, and then to determine reporting requirements, patient tracking and testing, and information sharing. An enhanced surveillance advisory will last for 60 days only, unless the governor renews the order, and may be revised or terminated at any time by the director of the Department of Health Services. Enhanced surveillance advisories trigger increased reporting and information-sharing requirements and specific patient-tracking and specimen-testing capabilities.
The governor may declare a state of emergency due to the occurence or threat of an epidemic or pandemic disease posing a “substantial risk of a significant number of human fatalities or incidents of permanent or long-term disability.” The Department of Health Services will have primary jurisdiction, responsibility and authority during such a state of emergency over planning; coordinating; and organizing public health assessments, preparedness response, recovery and mitigation operations, and public information. The department also has authority to adopt a temporary professional licensing process for any professionals or health care institutions required to address the state of emergency. The governor can issue orders mandating medical examinations, rationing medicine and vaccines, and providing transportation or medical supplies.
During a state of emergency, the Department of Health Services or local health authority must investigate if there is reasonable cause to believe a highly contagious and fatal disease exists within the jurisdiction. The director of the Department of Health Services may order quarantine or isolation of any persons who have contracted or been exposed to the disease—by written directive detailing the person, conditions and reasons for confinement—if this is the least restrictive means to protect the public from transmission. Unless there is an immediate and serious threat to public health, a written order from the court is required to order quarantine or isolation. Within 10 days of issuing a written directive, the department or local health authority must file a petition for a court order authorizing the confinement, along with a sworn affidavit attesting to the facts. A hearing on the petition will be held within five days, or within 10 days if extraordinary circumstances necessitate, and the petition will be granted if the quarantine or isolation is shown by a preponderance of the evidence to be reasonably necessary to protect the public health. The court-ordered quarantine or isolation may not exceed 30 days; however, the department or the local health authority may move to continue it for an additional period of up to 30 days, upon the same standard as the first application.
Quarantine can occur in the residence of the individual or a place established and maintained by the Department of Health Services or local health authority for such purposes. The state will be responsible for providing adequate food, clothing, medicine, medical care, and means of communicating with persons inside or outside of confinement. Persons subject to quarantine or isolation must comply with any department or local health authority orders and may not go beyond the premises or come into contact with anyone other than a physician, health care provider or other authorized persons. Any person who enters premises placed under quarantine or isolation without authorization, and therefore poses a danger to public health, may also be placed in quarantine or isolation. Quarantine or isolation must be terminated if the department or local health authority determines that it is no longer necessary to protect the public health.
Arizona also provides due process for persons subject to quarantine or isolation during a state of emergency. Persons ordered quarantined or isolated have a right to counsel, at state expense, for the duration of their confinement. Individuals can request a court hearing regarding their treatment or conditions of confinement. The hearing must take place within 10 days of the request, and the court may provide remedies “appropriate to the circumstances of the state of emergency” if it finds the conditions do not comply with these statutory provisions.
Arkansas’s State Board of Health has the power to make all necessary and reasonable rules of a general nature for the health and safety of the public. This includes “the suppression and prevention of infectious, contagious, and communicable diseases” and “the proper enforcement of quarantine, isolation, and control of such diseases.” Section 20-7-110(a)(2) of the Arkansas Code gives the State Board of Health direction and control over all quarantine regulation and enforcement. Part (b) of this same section also gives the governor the power to present specific facts to the State Board of Health “whenever the health of the citizens of [Arkansas] is threatened by the prevalence of any epidemic or contagious disease in this or any adjoining state and, in the judgment of the Governor, the public safety demands action on the part of the board.”
Section 14-262-102 of the Arkansas Code allows municipalities and townships to have their own health boards. Under Subsection (c) of this law, city councils can give their health boards any powers necessary to “[s]ecure the city and its inhabitants from the evils of contagious, malignant, and infectious diseases.” Each municipality or incorporated town can also create a health officer, who is a legally qualified physician elected by the city or town council. Section 14-262-103(d)(3) requires these officers to “discharge and perform such duties as may be prescribed for him or her under the directions, rules, regulations, and requirements” of the State Board of Health and the relevant municipal or township board of health. Additionally, Section 14-262-103(d)(5) requires health officers to aid the state and municipal medical boards in the “enforcement of proper rules, regulations, and requirements” related to “sanitary laws, quarantine regulations, and vital statistics collection.”
Section 14-262-109(2) and (3) requires each county and district health department to “investigate and control the cause of epidemic and communicable disease affecting the public health” and “establish, maintain, and enforce isolation and quarantine” when necessary for the protection of the public health. When a state, county or municipal health officer has reasonable grounds to believe that any person has tuberculosis in an active state or in a communicable form and that person is refusing to seek a medical examination or treatment, Section 20-15-703(a) allows health officers to apprehend that individual and detain him or her for the necessary tests and examinations. If that person is found to have tuberculosis, part (b) of the same statute places a duty on the health officer to determine whether that person needs to be quarantined. Section 20-15-703 is phrased broadly, so it is unclear to what extent it applies to managing other communicable diseases.
Under Section 20-7-109(b), “if a patient can be treated with reasonable safety to the public health, he or she shall not be removed from his or her home without his or her consent.” However, section 20-15-704 states that if “the health officer finds that the circumstances are not suitable for proper isolation or contagious control of the case by any type of local quarantine” and the person is a source of danger to others, “then the health officer shall petition the circuit court of the individual’s county” to order the admission of the person to any state-owned and state-operated hospital.
Any firm, person or corporation that violates a quarantine order can be found guilty of a misdemeanor under Section 14-262-101. The penalty can consist of a fine between $100 and $500 and imprisonment of up to one year. Each day that a firm, person or corporation violates a lawful order pursuant to these laws counts as a separate offense.
According to the California Health and Safety Code, California grants a broad and fairly unstructured power to the state’s Department of Health Services to “adopt and enforce regulations requiring strict or modified isolation, or quarantine, for any of the contagious, infectious, or communicable diseases, if in the opinion of the department the action is necessary for the protection of the public health.” Local health officers also have broad authority to issue orders to other government entities in their jurisdiction in the event of “an outbreak of a communicable disease, or upon the imminent and proximate threat of a communicable disease outbreak or epidemic that threatens the public’s health.” Under California’s Communicable Disease Prevention and Control Act, these health officers include county, city and district health officers.
Only probable cause, or “reason to believe,” that an individual is infected with a communicable disease is required for a health official to institute a quarantine order. All health officials are required to enforce any order, rule or regulation issued by the department with regards to quarantine or isolation and to immediately report every known or suspected case of the disease to the department within 24 hours of discovery.
Local health officials are responsible for notifying and updating government entities regarding all relevant information, including location and number of cases and steps government could take to address the threat. All health care providers and clinics, as well as pharmacies, suppliers and distributors are required to disclose medical supplies and vaccines upon request of a local health officer.
In California, quarantines have been instituted in hospitals and jails, or by confining persons in their homes. A person subject to quarantine or strict isolation “shall not go beyond the lot where the building, house, structure, or other shelter is situated, nor put himself or herself in immediate communication with any person not subject to quarantine, other than the physician, the health officer or persons authorized by the health officer.” California law also prohibits teachers and students residing in a place subject to strict isolation or quarantine of contacts from attending school without written permission of the health officer.
All persons must obey any order, rule or regulation issued by a health official regarding quarantine or isolation. Noncompliance with any department rule, including violation of terms of quarantine or isolation, is a misdemeanor offense. It is also a misdemeanor offense for any person charged with performance of any duty relating to the preservation of the public health to willfully neglect or refuse to perform such a duty.
In the 1921 case of In re Culver, a minor child who had been exposed to diphtheria was ordered quarantined in her home. A police officer placed a warning placard on the door of the residence by order of the state board of health, but the child’s aunt removed the sign. The woman was prosecuted for the misdemeanor offense of violating an order of the board respecting a quarantine and the Supreme Court of California upheld the conviction. In the 1966 case of In re Halko, a patient with pulmonary tuberculosis was quarantined in a hospital where he was receiving treatment. The patient left the hospital in violation of the quarantine order and later was convicted for the violation. Prior to serving his sentence, he was served with a series of successive isolation orders returning him to the hospital due to his condition. He petitioned for writ of habeas corpus arguing that the state statute ordering his confinement was unconstitutional because he suffered a continual deprivation of his liberty without any ability to judicially challenge the health officer’s conclusion. The California Second District Court of Appeals denied his petition, upholding the statute as reasonable and necessary to protect the public health.
Under Colorado’s Revised Statutes Section 25-1-506, each county or district public health agency is assigned a range of duties to protect the public health, including to “investigate and control the causes of epidemic or communicable diseases and conditions affecting public health” and to “establish, maintain, and enforce isolation and quarantine, and in pursuance thereof, and for this purpose only, to exercise physical control over property and over the persons of the people within the jurisdiction of the agency as the agency may find necessary for the protection of the public health.”
The Department of Public Health and Environment has similar powers and duties, including closing theaters, schools and other public establishments; forbidding gatherings of people; setting standards for diagnostic tests; purchasing and distributing vaccines and other products; establishing sanitary standards for the maintenance of public homes, facilities and spaces; disseminating public health information; and gathering and maintaining any necessary information and data. The department also has the ability to establish and enforce quarantine and isolation, and in pursuance of these orders, may exercise physical control over property and persons as necessary for the protection of the public health. In the event of a pandemic influenza, the department is authorized to enter into partnerships to purchase and stockpile antiviral therapies.
Under Section 24-33.5-704.5, the governor of Colorado has an expert emergency epidemic response committee, made up of officials such as the executive director, chief medical officer, chief public information officer, emergency response coordinator and state epidemiologist of the Department of Public Health and the attorney general, director of the division of homeland security and emergency management, and more. The governor will also appoint several categories of persons to the committee, including licensed physicians in infectious disease and emergency medicine, a medical examiner, a specialist in posttraumatic stress management, and more. The committee is charged with creating management programs regarding public health crises, including pandemic influenza and epidemics caused by novel and highly fatal infectious agents, and providing public health advice to the governor in the event of an epidemic.
If there is evidence of an occuring or imminent threat of an emergency epidemic, the governor can convene the committee to investigate. If the committee confirms the emergency epidemic, it will then advise the governor to declare a disaster emergency. Once the governor has declared a disaster emergency, the committee will continue to convene to advise the governor regarding reasonable, appropriate measures to initiate, by executive order, in order to reduce or prevent spread of the disease, including procuring or gathering medical supplies and vaccines, ordering transfer of patients, isolating or quarantining persons or property, assessing the adequacy of food and water supplies, and providing information and advice to the public and mental health support to affected persons.
Finally, under Sections 25-1.5-601-613, Colorado provides a set of regulations regarding volunteer health practitioners who are employed by disaster relief organizations while an emergency declaration is in effect.
If the Connecticut governor declares a public health emergency, under Conn. Gen. Stat. § 19a-131a, the governor can authorize the health commissioner to isolate or quarantine individuals. Section 19a-221 also gives local health directors the power to order quarantine or isolation when a director “has reasonable grounds to believe” an individual is “infected with a communicable disease.” The director must determine that the individual “poses a substantial threat to the public health” and isolation or quarantine must be “necessary to protect or preserve the public health.” However, if the governor declares a public health emergency pursuant to Section 19a-131a, local authorities must “comply with and carry out” orders the state commissioner issues in furtherance of the declaration of the public health emergency.
If the governor declares a public health emergency and an individual violates the provisions of a quarantine or isolation order or obstructs someone who is authorized to carry out such an order, the individual is subject to a fine up to $1,000, imprisonment up to one year, or both, for each offense. Additionally, if an individual refuses to comply with a quarantine or isolation order, the commissioner may also “direct any law enforcement officer to immediately take such individual into custody and place him or her into quarantine or isolation, as the case may be.”
Section 19a-131b provides the conditions for quarantine and isolation, the procedures the commissioner must follow when quarantining or isolating individuals, and the procedures for individuals to appeal an order and have a hearing. The commissioner may order an individual, group of individuals, or anyone “present within a geographic area” into quarantine or isolation. The commissioner must have “reasonable grounds” to believe that the individual is “infected with, or exposed to, a communicable disease” or is “at reasonable risk of having a communicable disease” or passing the disease to other individuals. The commissioner must determine that “such individual or individuals pose a significant threat to the public health[,]” that quarantine or isolation is “necessary[,]” and that such a measure is “the least restrictive alternative to protect or preserve the public health.”
The statute provides nine “conditions and principles” that the commissioner must adhere to when exercising the power to quarantine or isolate an individual or group of individuals. First, the measures themselves must be tailored to utilize the “least restrictive means necessary to prevent the spread of a communicable disease or contamination to others.” Second, individuals who are quarantined and those who are isolated must be “confined separately” from each other. Third, officials must frequently monitor the health status of individuals who have been quarantined or isolated “to determine if they continue to require quarantine or isolation.” Fourth, if a quarantined individual becomes infected “or is reasonably believed to have become infected with a communicable disease” after being quarantined, the individual must be moved to isolation.
Fifth, officials must immediately release individuals “when they are no longer infectious or capable of contaminating others or upon the order of a court of competent jurisdiction.” Sixth, officials must address the needs of those quarantined or isolated “in a systematic and competent fashion.” This includes “providing adequate food, clothing, shelter, means of communication with those in quarantine or isolation and outside those settings, medication and competent medical care.” Seventh, the premises officials use for quarantine and isolation must be kept safe and hygienic and “be designed to minimize the likelihood of further transmission of infection or other harms to individuals quarantined or isolated.” Eighth, officials must keep family members and members of a household together “to the extent possible without jeopardizing the public health.”
Finally, officials must consider cultural and religious beliefs “to the extent possible” when addressing individual needs and “establishing and maintaining premises used for quarantine and isolation.” If an individual in quarantine or isolation wants to be treated “by prayer or spiritual means without the use of any drugs or material remedies, but through the use of the principles, tenets or teachings of any church incorporated under [a chapter of the statutes] or any other religious or spiritual practice,” the individual has the right to be treated in this manner.
When the commissioner issues a quarantine or isolation order, it must be in writing. Among other items, it must include the period of time that the order will remain effective, “the basis for the commissioner’s belief regarding the presence of a communicable disease,” and “other terms and conditions as may be necessary to protect and preserve the public health.”
When determining the time period of the order, the commissioner must consider “to the extent known, the length of incubation of the communicable disease or contamination, the date of the individual’s exposure and the individual’s medical risk of exposing others to such communicable disease or contamination.” The order may not be effective for more than 20 days, though further orders may be issued for successive periods of no more than 20 days.
A quarantine or isolation order must also inform individuals subject to it that they have the right to consult an attorney and the right to a hearing. It must include “clear instructions on how to request a hearing,” and that if an individual does so, the individual has the right to be represented by counsel at the hearing. If the individual cannot afford counsel, the state must provide counsel. At a hearing, the individual also has the right to cross-examine testifying witnesses. Court fees must be waived for such a hearing.
If the order applies to a group of individuals present in a geographic area, the court can appoint one or more attorneys to represent everyone in the area “where there is a commonality of interests of such individuals.” However, “an individual may choose to be represented by his or her own attorney on an individual basis.”
An individual who is subject to a quarantine or isolation order may appeal the order to the Probate Court for the district in which the individual is quarantined or isolated, though the request does not stay the quarantine or isolation order. If the individual requests a hearing, the court must hold the hearing no later than 72 hours after receiving the request, though the “court may extend the time for a hearing based on extraordinary circumstances.” There is also no fee to file an appeal.
All parties, including the Probate Court, must have access to all records prior to the hearing. Records that relate to the individual’s condition are admissible at the request of any party or the court at the hearing. Parties are permitted to timely object to the “admissibility of evidence in accordance with the rules of civil procedure.”
At the hearing, the commissioner has the burden of showing that the necessary conditions of the statute are met by a preponderance of the evidence. If the court finds that the conditions are met, it must order either the continued quarantine or isolation of the individual “under such terms and conditions as the court deems necessary to prevent the exposure of others to a communicable disease” until the commissioner determines that releasing the individual “would not constitute a reasonable threat to the public health,” or the release of the individual “under such terms and conditions as [the court] deems appropriate to protect the public health.” If the court finds that the conditions have not been proved, it must order the individual’s immediate release.
An individual may move the court to terminate or modify its order every 30 days. If the individual does so, another hearing will be held. The court may modify its order if it determines that the condition for quarantine or isolation still exists but a different remedy is appropriate.
“Any person aggrieved” by a Probate Court order may appeal to the Superior Court.
Section 19a-221, which describes the mechanisms for local authorities quarantining or isolating individuals, provides for essentially identical procedures.
In Delaware, Title 20 Section 3115(a) makes the governor “responsible for addressing the dangers to life, health, environment, property or public peace within the State presented by emergencies or disasters.” Section 3102 defines an emergency as “any situation which requires efforts and capabilities to save lives or to protect property, public health and safety, or to lessen or avert the threat of a disaster in Delaware.” Section 3115(b) allows the governor to declare a state of emergency after it is found that “an emergency or disaster has occurred or that such occurrence ... is imminent.” A state of emergency can “continue until the Governor finds that the threat or danger has passed or the emergency or disaster has been dealt with to the extent that conditions necessitating a state of emergency no longer exist.” However, no state of emergency can exceed 30 days without being renewed.
During an emergency, Section 3116 allows the governor to:
Utilize all available resources of the state government as reasonably necessary to cope with the emergency or disaster.
Employ such measures and make such recommendations to state or local health agencies, authorities or boards as may be reasonably necessary.
Direct and compel the evacuation of all or part of the population from any stricken or threatened area within the State if this action is necessary for the preservation of life.
Prescribe routes, modes of transportation, and destinations throughout the State in connection with evacuation.
Control ingress and egress to and from a disaster area, the movement of persons within the area, and the occupancy of premises therein.
In addition to the governor, Title 16 Section 130(a) makes the secretary of health and social services or a designee initially responsible for implementing all measures designed to address potential contagious diseases or infectious diseases. Subsections (b) and (e) require health care providers, veterinarians and livestock owners to report all cases of any illness or health conditions that may be potential causes of a public health emergency. Section 505 allows the director of the Division of Public Health or the director’s designee to:
declare certain diseases to be communicable and may by regulation lay down the procedure which is to be followed by the patient or person suffering therefrom, the parents of the patient, the householder, by the physician attending on the patient or any individual brought into contact with or responsible for the care or maintenance of the patient in order that the transference of the disease to other individual or individuals may be prevented.
This regulation can provide for the quarantine or isolation of any person or persons who have been exposed to the disease or carry the disease, any other matter relating to the care of and due to the illness of the patient from the communicable disease, and any other matter or procedure of interest in the protection of the public.
During a state of emergency, Title 20 Section 3136 allows the Delaware governor to activate several isolation and quarantine procedures. When these powers are activated, Section 3136(1)(c) acknowledges that “all reasonable means shall be taken to prevent the transmission of infection among the isolated or quarantined individuals.” But this section also requires the governor to use the “least restrictive means necessary to protect the public health.” Under Subsection (2) of this section, “[p]ersons shall be isolated or quarantined if it is determined by clear and convincing evidence that the person to be isolated or quarantined poses a significant risk of transmitting a disease to others with serious consequences.” This same section also stipulates that “[i]solation or quarantine of any person shall be terminated when such person no longer poses a significant risk of transmitting a disease to others with serious consequences.”
Subsection (4) of this section mandates that:
[a] person subject to isolation or quarantine shall obey the public safety authority’s rules and orders, shall not go beyond the isolation or quarantine premises, and shall not put himself or herself in contact with any person not subject to isolation or quarantine other than a physician or other health care provider, public health authority, or person authorized to enter isolation or quarantine premises by the public safety authority.
Additionally, Subsection (4)(b) prevents any nonauthorized personnel from entering quarantined premises.
Subsection (3) of the section requires “adequate food, clothing, medication and other necessities and competent medical care” be provided to individuals who are isolated. Subsection (3)(c) also requires “the health status of isolated and quarantined individuals be monitored regularly to determine if their status [has] changed.” Additionally, Subsection (5) outlines a series of due process protections for individuals subject to a quarantine order. To start, Subsection (5)(a) requires the public safety authority to “petition the Superior Court for an order authorizing the isolation or quarantine of an individual or groups of individuals.” Under Subsection (5)(b), the petition must specify:
The identity of the individual or group of individuals subject to isolation or quarantine;
The premises subject to isolation or quarantine;
The date and time at which the public safety authority request isolation or quarantine to commence;
The suspected contagious disease, if known;
A statement of the basis upon which isolation or quarantine is justified.
A statement of what effort, if any, has been made to give notice of the hearing to the individual or group of individuals to be isolated or quarantined, or the reason supporting the claim that notice should not be required.
But under Subsection (2), “a person’s refusal to accept medical examination, vaccination or treatment ... shall constitute prima facie evidence that said person should be quarantined or isolated.” If necessary, Subsection (5)(d) allows the public safety authority to temporarily quarantine individuals prior to a hearing. When this occurs, Subsection (5)(e) requires the court to have a hearing within 72 hours after an individual or group of individuals has been isolated or quarantined. Subsection (6) also allows a quarantined individual to file a petition for a court hearing, which must occur within 10 days of the petition. Subsection (7) gives the petitioner the right to be represented by counsel or other lawful representative and requires the state to provide counsel to indigent persons.
Subsections (6)(c) also provide remedies for individuals wrongfully quarantined. Specifically, if “the Court finds that the isolation or quarantine of the individual is not warranted under the provisions of this section, then the person shall be immediately released from isolation or quarantine.” Furthermore, if the court finds that these individuals were not quarantined properly, it may “fashion remedies appropriate to the circumstances.” Additionally, Subsection 6(d) prevents Delaware-based employers from permanently terminating anyone placed in quarantine.
Finally, Title 16 Section 107(a) makes refusing or failing to perform the duties required under the above laws punishable by a fine of not less than $100 and not more than $1,000 plus the costs these actions imposed.
D.C. Code Section 7-131 provides that the mayor may “issue rules to prevent and control the spread of communicable diseases” upon the advice of the director of the Department of Health. These rules can include “[r]equirements and procedures for restriction of movement, isolation, and quarantine.” If the mayor consults with the director and has “probable cause” to believe that an individual has a communicable disease and the individual’s “presence in the general population is likely to cause death or seriously impair the health of others[,]” the mayor may order that the individual be removed for isolation, quarantine or treatment. The order must be in writing and state the location of the detention. The mayor can do the same for groups of people.
The written order constitutes the authority to detain an individual or group until it expires. It expires within 24 hours of issuance unless a Superior Court judge “continues its force and effect for a longer period.” The judge can do so “if the judge finds that probable cause exists to believe that the detained person’s presence in the general population is likely to cause death or seriously impair the health of others.”
If the judge does continue an order, individuals or groups may petition for a hearing to determine whether they are affected with a communicable disease, and if they are, whether their release “into the general population is likely to cause death or seriously impair the health of others.” The hearing must take place as soon as it is “practicable” to do so “but no later than 10 days after the court receives the petition.”
The mayor must order medical examinations of individuals who are detained to determine whether they have a communicable disease and immediately discharge anyone who does not. The diagnosis resulting from the exam must be in writing and the examining physician must sign it. Authorities may detain anyone who has been diagnosed as “affected with a communicable disease” for as long as it is “necessary to protect the public health.” An individual who has been detained pursuant to this authority may petition the Superior Court at any time for a discharge hearing. The individual who petitions for a hearing must be provided with counsel if the individual cannot afford counsel.
It is unlawful for a detained individual to leave any place or institution that the mayor has ordered the individual to remain in unless the individual is discharged pursuant to the manners described.
The Superior Court may issue a warrant for the arrest of an individual based on probable cause to believe that the individual has a communicable disease to aid the mayor in the removal and detention of the individual. If the individual has been detained pursuant to such a warrant, the individual may only be discharged in the second manner described, where detention is authorized for as long as necessary to protect the public health and the individual may petition the court for a discharge hearing.
The warrant may only be issued if there is probable cause, if it is supported by an affidavit or affidavits particularly describing the individual, and if the affidavit(s) set forth the facts supporting the application or probable cause for believing that the facts exist.
Any Metropolitan Police Deparment officer can execute the warrant. The officer is permitted to “break open any outer or inner door or window of a house, or any part of a house,” or anything within the house, to execute the warrant, but only if the individual refuses to admit the officer after the officer gives “notice of his authority and purpose.” A warrant is valid for only 10 days after the court issues it.
There is a statutory exemption for individuals who rely on spiritual or religious means to cure disease “in good faith.” Health officers are permitted to confine such individuals to a hospital or other medical institution only if “no other place for quarantine of such person, minor child or ward can be secured.” Additionally, health officers cannot compel individuals relying on spiritual means to submit to any medical treatment.
The final provision in the subchapter on the prevention of the spread of communicable diseases is on construction of the preceding provisions. It states that all provisions in the subchapter “shall be constructed liberally in aid of the powers vested in the public authorities looking to the protection of the public health, comfort, and welfare and not by way of limitation.”
Florida provides very little specification for the process and conditions of isolation or quarantine, instead providing broad discretion to the state’s Department of Health and its agents.
Under Section 381.00315 of the Florida code, the state health officer, who is also the state surgeon general, is “responsible for declaring public health emergencies, issuing public health advisories, and ordering isolation or quarantines.” The Department of Health has the duty and authority “to declare, enforce, modify, and abolish the isolation and quarantine of persons, animals, and premises as the circumstances indicate for controlling communicable diseases or providing protection from unsafe conditions that pose a threat to public health.” Any such order will be immediately enforceable by law enforcement.
The department is empowered to create rules specifying conditions and procedures of isolation or quarantine, including closure of premises; movement of persons or animals exposed or infected; tests or treatment, including vaccination, required before employment, admission to premises or to comply with an isolation or quarantine; testing or destruction of animals suspected of infection dangerous to humans; access by the department to isolated or quarantined premises; disinfection of isolated or quarantined animals, persons or premises; and methods of isolation or quarantine.
The department is also authorized to bring “all proper and necessary actions and proceedings” to enforce these rules, including for temporary or permanent injunctions restraining a person from violating any of these provisions or for proceedings to compel performance of any act specifically required of a person, officer or board by any public health law. The department may request warrants directing any sheriff, deputy, or police officer to assist in carrying out the purpose and intent of these provisions in any way. All state and county attorneys, sheriffs, police officers and other appropriate city and county officials have a duty, upon request by the department or its agents, to assist in enforcing these public health laws and rules. Additionally, during a public health emergency, any person who assists the state health officer at his or her request on a volunteer basis is entitled to benefits granted in Section 110.504.
Section 381.00315 also grants the state health officer power to declare a public health advisory or, if the disease “results or may result in substantial injury or harm to the public,” a public health emergency. During a public health emergency, the state health officer may take actions necessary to protect the public health, including directing drug manufacturers to give priority to shipping specified drugs to pharmacies and health care providers within specific geographic areas; directing pharmacists employed by the department to compound bulk prescription drugs and provide these drugs to physicians and nurses of county health departments or any qualified person authorized by the state health officer; temporarily reactivating inactive licenses of certain health care practitioners, if they are needed to respond to the public health emergency; and ordering an individual to be examined, tested, vaccinated, treated, isolated or quarantined for dangerous, communicable diseases.
Violation by any person of any rule or requirement adopted under these provisions or any isolation or quarantine order constitutes a second-degree misdemeanor.
The Georgia Department of Community Health and all county boards of health are empowered to “from time to time, require the isolation or segregation of persons with communicable diseases or conditions likely to endanger the health of others.” The department may also require quarantine or surveillance of individuals who have or are suspected of having an infectious disease.
The department must also ascertain the existence of an “epidemic or pandemic” illness or illness caused by “novel and highly fatal infectious agents or toxins” which “may pose a substantial risk of a public health emergency.” A public health emergency occurs when an “infectious agent or biological toxin” causes an illness or health condition (or an imminent threat of one) and there is a high probability that there will be a large number of deaths, a large number of “serious or long-term disabilities” or “[w]idespread exposure to an infectious or toxic agent that poses a significant risk of substantial future harm to a large number of people.” The department must then investigate any cases to determine their sources and “provide for proper control measures.”
The department and county boards of health may also require individuals to get vaccines, “whether or not the disease may be an active threat,” although there is an exception for when a person submits an objection on religious grounds outside an epidemic. The department may also require “such other measures to prevent the conveyance of infectious matter from infected persons to other persons as may be necessary and appropriate.”
Georgia Rule 511-9-1-.05 further describes the procedures Georgia authorities will follow for quarantine or isolation measures. First, an administrative order will be issued—presumably by the department or county board of health, though the rule does not specify—“when voluntary measures are deemed impracticable or ineffective.” These orders are effective when they are issued. An order may be issued orally if not doing so immediately would pose a “serious imminent danger to the public health.” A written order must also be issued as soon as possible, but no later than 24 hours after the oral order. The subject of the order must also receive notice of it.
An administrative order can include confinement in a location, “conditions on travel or behavior[,]” and “exclusion of individuals or groups from certain places.” The regulation provides for certain items the order must include, such as the grounds for believing the individual has been exposed or infected with a communicable disease and notice of the right to challenge the order.
When an individual is isolated or quarantined, the governmental authority ordering the measure must “preserve and facilitate the ability” of the person to “communicate with the outside world, and in particular to exchange confidential communications with legal and medical advisors of their choice.”
The regulations provide for the procedures for an appeal from an isolation or quarantine order pursuant to O.C.G.A. § 31-5-3, the general appeals statute for public health matters. Once the person who signed the order receives notice of the appeal, they must “immediately provide the Office of General Counsel and the subject of the appeal with a copy of all documents pertaining to the decision to issue the order and the grounds therefore.” The individual may request a hearing, but this request will not stay the order. If there is a hearing from an order issued by a county board of health, the Office of General Counsel designates the person who will hear it.
However, different “due process procedures” apply to vaccination or quarantine programs instituted during a public health emergency. The statute provides that the department must “permit access to counsel in person or by such other means as practicable that do not threaten the integrity of the quarantine.” This appeal can be pursued by an individual or a class, before “any available judge of the superior courts in the county where the individual or a member of the class resides or in Fulton County,” where the state capital of Atlanta is located.
When an individual appeals a vaccination or quarantine order, the burden of proof is on the state to show that “there exists a substantial risk of exposing other persons to imminent danger.” In vaccination cases, the state must meet this by clear and convincing evidence. In quarantine cases, the burden is a preponderance of the evidence. Rules of evidence that apply to civil cases will apply “to the fullest extent practicable.”
Additionally, all parties “have the right to subpoena and cross-examine witnesses,” though the court may consider any emergency circumstances when deciding to enforce such subpoenas. Any party may then immediately appeal to the Georgia Supreme Court, which will consider the appeal on an expedited basis. The statute states that these provisions will not “be construed to limit or restrict the right of habeas corpus under the laws of the United States.”
Notably, Georgia regulations also contain a catch-all provision for a state of emergency, during which “the Department shall establish any other public health control measures necessary to prevent and suppress disease and conditions deleterious to health as directed by the Governor.”
In Guam, the Division of Public Health and Social Services has the authority to impose isolation on any individual who has or is reasonably suspected of having a communicable disease and may impose quarantine on anyone who has come into contact with that individual.
The extent, location, duration and conditions of the restrictions imposed in any given case are at the discretion of the Division, “depending on the disease.” The period of restriction must match the minimum incubation period for the specific disease that is provided by the CDC, but should also include an additional period of time to test and confirm that the individual no longer has the disease. The Division must ensure that the restricted individuals are medically observed during that period.
This authority exists regardless of whether the individual gives their consent to be restricted.
The Division may place signs around the isolation or quarantine premises that warn the public not to enter, and no one may remove or deface those signs.
If the Division requests their assistance, the Guam Police Department must enforce any conditions of isolation or quarantine and may use “such force as may be reasonably necessary.”
If the Division deems it necessary, it may disinfect the premises of any quarantine or isolation, including the contents inside. In the event that the Division cannot safely disinfect any possessions like clothing or bedding, it may destroy them, but must provide a receipt to the individual detailing what items were destroyed. The individual may then use that receipt to request compensation.
In Guam, it is illegal for any person to conceal an individual who has a communicable disease; this prohibition extends to parents or guardians concealing infected children.
All health practitioners, directors of hospitals and laboratories, owners of hotels and inns, and captains of ships or airplanes must report to the Division any patients, clients or passengers who have or are suspected to have a communicable disease. They must report within 48 hours of discovery or diagnosis.
In a public health emergency, certain other conditions apply to quarantine and isolation imposed by the Division. First, isolation and quarantine must be implemented using the least restrictive measures necessary. If a quarantined individual subsequently becomes affected, they must be moved to isolation. The needs of restricted individuals, including food, clothing, shelter and communication with the outside world must be addressed in a “systematic and competent fashion.” To the extent possible, the restricted individual’s cultural and religious beliefs should be considered.
Any person who enters an area of quarantine or isolation without authorization from the Division is guilty of a misdemeanor offense and may be subject to isolation or quarantine themselves.
During a public health emergency, the Division may temporarily isolate or quarantine an individual or group through a written directive if delay in imposing the restriction would “significantly jeopardize” the Division’s ability to control the transmission of a contagious disease. The directive must state the identity of the affected individuals, the premises of restriction, the time at which the restriction begins, the suspected contagious disease and the relevant legal authority permitting the restriction.
Within 10 days after issuing the directive, the Division must file a petition for a court order authorizing the continued restriction of the individual(s). If it does not issue a directive, the Division must also file a petition before restricting anyone. The petition must include the identity of the affected individuals, the premises of restriction, the time at which the restriction begins, the suspected contagious disease, a statement of compliance with the relevant legal authority, and a summary of the factual basis for the restriction.
The Division must provide notice to the relevant individual or group within 24 hours of filing the petition. A hearing must be held within five days of the filing of the petition; in extraordinary circumstances and after showing good cause, the Division may ask to continue the hearing date for up to 10 days. The court may grant that continuance in its discretion but must consider the rights of the individuals, the protection of public health, the severity of the emergency, and the availability of necessary witnesses and evidence.
The court shall grant the petition if the Division shows, by a preponderance of the evidence, that the restriction is necessary to control the transmission of a contagious disease. The order lasts for no more than 30 days and must identify the relevant individual or group, specify the factual findings justifying the order, include all relevant conditions, and be served on the affected individual or group. Prior to the order’s expiration, the Division may request a continuance for another 30 day period, which the court may grant according to the standard laid out above.
A restricted individual or group may apply to the Superior Court of Guam for an order to show cause why they should be released. The court must rule on the application within 48 hours of its being filed and, if it grants the application, the court must schedule a hearing within 24 hours of issuing the order to show cause. The order to show cause does not stay the isolation or quarantine order.
A restricted individual or group may also request that the Superior Court of Guam hold a hearing for “remedies regarding breaches to the conditions of isolation or quarantine.” Such a hearing does not stay the isolation or quarantine order. If extraordinary circumstances justify the immediate granting of relief, the court must schedule a hearing within 24 hours of receiving the request; if there are no extraordinary circumstances, the hearing must be scheduled within five days of receiving the request.
Any proceedings brought before a court must be held on the record. If parties cannot participate in person, the proceedings may be conducted by their authorized representatives or held via remote means that allow “all parties to fully participate.”
The court must appoint counsel to all parties who are not otherwise represented; appointed counsel will be paid by the government of Guam. The Division must provide adequate means of communication between affected individuals or groups and their counsel.
Any court may order the consolidation of individual claims into groups when the number of individual claims would make separate hearings impractical, there are questions of law or fact common to each claim, the group rights claimed are typical of the individual’s claims, and the group as a whole will be “adequately represented in the consolidation.”
The state code of Hawaii grants the governor and, in certain cases, mayors broad emergency management powers. Section 127A-12 of the code allows the governor or any mayor to “restrict the congregation of the public in stricken or dangerous areas or under dangerous conditions.” They may also direct and control the “non-compulsory evacuation of the civilian population.”
Once a state of emergency has been declared, Section 127A-13 goes further still and allows the governor to “require the quarantine or segregation of persons who are affected with or believed to have been exposed” to any communicable disease that is, according to the governor, “dangerous to the public health and safety.” The governor may also designate as public nuisances any conduct that is “dangerous to the public health.”
The governor’s powers extend even further than those two functions, however. Section 127A-13 endows the governor with the abilities to suspend any law that “impedes or tends to impede” the execution of emergency functions and to “direct and control the mandatory evacuation of the civilian population.”
The statute grants Hawaii mayors similarly broad authority during a local state of emergency, including the power to suspend any county law that “impedes or tends to impede” the execution of emergency functions and to also “direct and control the mandatory evacuation of the civilian population.”
Chapter 325 of the Hawaii state code specifically addresses communicable diseases, with Section 325-8 detailing the procedures for the quarantine of infected individuals. In order to quarantine an individual, the Department of Health must obtain a written, ex parte order from the state circuit court with jurisdiction over the individual’s residence. The court may grant the order upon finding that probable cause exists to justify the quarantine. The department must provide a copy of the order to the individual and notify them of their right to a hearing if they wish to contest the order.
That procedure may be suspended if “any delay in the quarantine of the individual would pose an immediate threat to the public health.” Following such a quarantine, the Department of Health must immediately obtain an ex parte order from the relevant court retroactively authorizing the procedure.
Individuals who wish to exercise their right to a hearing must file a written request with the court that issued the subpoena. The hearing will be held within 14 days of that filing, but such a request will not lift the restrictions of the quarantine. At the hearing itself, the Department of Health must demonstrate with clear and convincing evidence that the quarantine is justified for the court to continue its order.
All individuals subject to quarantine must stay within the designated premises and not come into contact with anyone other than a health care provider. Violating that restriction is a misdemeanor offense. Moreover, no one is allowed to enter the quarantine premises without permission from the Department of Health. Anyone who enters a quarantine premises without permission is also subject to quarantine and has also committed a misdemeanor offense. Additionally, Section 325-2 requires that all medical professionals treating patients with confirmed or suspected cases of a dangerous disease must report the incidence to the Department of Health. Failure to report may result in a fine of up to $1,000.
The Department of Health must provide the quarantined individual with food, clothing, medication, access to counsel, the ability to communicate with the outside world and competent medical care. The department must also consider the individual’s cultural and religious beliefs “to the greatest extent possible.”
Section 325-9 allows for the Department of Health to quarantine a person in the home in which they reside if the department determines that removing the person from their home would endanger their life or the health of the department’s agents. In such a case, the department may remove the residents of the surrounding neighborhood and take “any such other measures” that it deems necessary for the public health and safety. All local law enforcement officers are required to assist department officials in this process.
Idaho’s state code gives state, regional and municipal authorities overlapping power to pursue quarantines and other measures relating to public health.
The director of the state Department of Public Health and Welfare has the power to “impose and enforce orders of isolation and quarantine” to prevent the spread of infectious diseases. A state isolation or quarantine order is subject to a de novo judicial standard of review, meaning that the court gives the agency’s expertise no specific deference. The reviewing court must affirm an isolation or quarantine order if it appears that, by a preponderance of the evidence, the order is “reasonably necessary to protect the public from a substantial and immediate danger.” Violating an isolation or quarantine order is a misdemeanor offense.
In addition to the state health department, Idaho is divided into seven public health districts. Each district shares the same quarantine powers endowed to the state health department. Cities may also establish their own separate boards of health and pass regulations affecting a quarantine within five miles of their city limits.
The state’s administrative code spells out its isolation and quarantine restrictions with slightly more specificity. At the time of issuing an isolation or quarantine order, the responsible entity—either the state Department of Public Health and Welfare or a local public health district—must determine “the least restrictive timeframe of quarantine that effectively protects” the public. The same entity will withdraw the order when it determines that the individual or premises under restriction no longer pose a significant threat to public health.
No individual under isolation or quarantine may travel or be transported without the permission of the issuing entity. Finally, officials from the state Department of Public Health and Welfare may enter private or public property in order to administer or enforce all state public health regulations, including those relating to infectious diseases.
Illinois provides detailed procedures in this area. The state’s Department of Public Health has “general supervision of the interests of the health and lives of the people of the State.” The department has “supreme authority” over quarantine and isolation and may establish or modify either. Local authorities must enforce the rules, regulations and orders that the state department adopts. Counties also have power to “make and enforce such rules and regulations tending to check the spread of the disease within the limits of the county or town as may be necessary” and the board of health may quarantine any house or houses or place. And municipalities have jurisdiction to enforce health and quarantine ordinances and regulations.
The Department of Public Health has the authority to order quarantine or isolation for an individual or group or order a place closed until the situation can be “corrected” or there is no longer a “substantial danger to the public’s health.”
Illinois, however, provides that quarantine or isolation of a person or closure of a place cannot occur without either the consent of the person or owner of the place or a prior court order. There is an exception for this if the department reasonably finds that “immediate action is required to protect the public from a dangerously contagious or infectious disease.” If the department makes this kind of immediate order, it must obtain consent or request a court order “as soon as practical,” but within 48 hours at the latest.
To receive a court order, the department must prove by clear and convincing evidence that
the public’s health and welfare are significantly endangered by a person or group of persons that has, that is suspected of having, that has been exposed to, or that is reasonably believed to have been exposed to a dangerously contagious or infectious disease ... or by a place where there is a significant amount of activity likely to spread a dangerously contagious or infectious disease.
It must also demonstrate that any reasonable alternatives have been exhausted and there are no less restrictive options available.
The statute provides that any individuals “who are or are about to be ordered to be isolated or quarantined and owners of places that are or are about to be closed and made off limits to the public shall have the right to counsel.” If these individuals are indigent, the court must appoint counsel.
Individuals must be provided with written notice of any order pursuant to this statute. The notice must be fairly detailed: It must include “(1) notice of the right to counsel; (2) notice that if the person or owner is indigent, the court will appoint counsel for that person or owner; (3) notice of the reason for the order for isolation, quarantine, or closure; (4) notice of whether the order is an immediate order, and if so, the time frame for the Department to seek consent or to file a petition requesting a court order as set out in this subsection; and (5) notice of the anticipated duration of the isolation, quarantine, or closure.”
Illinois further authorizes the department to order physical examinations and tests and gather laboratory specimens that are not reasonably likely to result in serious harm to an individual. It further permits the department to “order the administration of vaccines, medications, or other treatments as necessary” and these treatments also may not be reasonably likely to result in serious harm. It may also order monitoring and observation.
It is a Class A misdemeanor for anyone to “knowingly or maliciously disseminate[] any false information” about the existence of a contagious disease “in connection with the Department’s power of quarantine, isolation and closure or refuse[] to comply with a quarantine, isolation or closure order.”
The department is also tasked with investigating the causes of contagious diseases, “especially when existing in epidemic form,” and working to suppress such diseases. If it finds that a local board of health or local authorities are not properly responding to a disease that may become or is becoming an epidemic, it “may enforce such measures as it deems necessary to protect the public health,” and the locality will pay all “necessary” expenses.
Additionally, Illinois provides that, to prevent the spread of a disease, the department and local authorities will have emergency access to medical records on the condition that the government authorities protect the privacy and confidentiality of such records.
In a 1994 case, Moore v. Lumpkin, an Illinois court found that the statute committed broad discretion to the department to determine the measures it takes to investigate and to suppress contagious diseases.
In Indiana, the power to establish quarantines rests with the state Department of Health, but a public health authority may request one from a local judge. In the case of a public health emergency, or if the department believes that a local health authority is not enforcing the laws and regulations necessary to protect public health, the department may enforce the powers of the local health authorities as well as its own.
If a public health authority believes that an individual has been infected with or exposed to a dangerous communicable disease, and that the individual might infect other people without some form of movement restriction, the authority may petition a circuit or superior court for a quarantine or isolation order. The petition must include a brief factual summary of the facts underlying the request, including any efforts by the authority to obtain the individual’s “voluntary compliance” with isolation or quarantine measures.
The individual in question is entitled to proper notice and an opportunity to be heard before the court issues the order. The court may restrict the individual’s physical appearance at this hearing if it believes that such an appearance would contribute to infecting another person. The public health authority must prove that a quarantine or isolation is required by clear and convincing evidence. When issuing the quarantine or isolation order, the court must detail the conditions of the restriction, including its duration.
If the public health authority believes that the individual will likely cause further infections before having an opportunity to be heard, it may file a verified petition for emergency quarantine or isolation, which must include the same information mandated for a nonemergency quarantine petition. In such an instance, the public health authority must, in a nonadversarial setting such as by telephone or in a recorded hearing, prove to the court by clear and convincing evidence that the emergency order is necessary. If the court grants the emergency order, it will remain valid for 72 hours, excluding weekends and legal holidays.
Once the court grants the petition or emergency petition, the public health authority may file a petition for renewal if it determines one to be necessary. The petition for renewal must also include a brief factual summary of the facts underlying the request, as well as any efforts by the authority to obtain the individual’s “voluntary compliance” with the extended restrictions.
Additionally, the public health authority must provide the individual with at least 24 hours’ notice of the renewal hearing. The individual may again appear before the court at the hearing, unless the court deems that appearance to risk the spread of the disease. At the renewal hearing, the individual is allowed to cross-examine any witnesses that the public health authority calls. As with the initial petition, the public health authority must prove the necessity of the renewal petition by clear and convincing evidence.
The state must appoint an attorney for an indigent individual who is the subject of a petition for quarantine or isolation. The public health authority that imposes a quarantine order not in the individual’s home must, if the individual is a child, allow the individual’s parent or guardian to remain with the child in quarantine. If the individual is an adult, the public health authority may allow another adult to remain with the individual in quarantine.
If an individual who is placed under quarantine is the sole guardian of one or more children, the children will be placed in the care of a relative, according to the guidance of the guardian when possible.
Any violation of an order of quarantine or isolation is a Class A misdemeanor.
The power to quarantine or isolate rests in Iowa with the state and local boards of health. Any health care provider treating a person with a reportable disease must immediately notify the State Board of Health. The health care provider must provide a host of demographic information about the patient, including the patient’s name; address; date of birth; marital status; and, if the patient is female, whether or not she is pregnant. The patient’s identity shall remain confidential, but the state health board may release anonymized information about the patient to the public.
At their discretion, the state and local boards of health may impose and enforce isolation and quarantine restrictions, by force if necessary. The type and length of isolation or quarantine imposed for a specific disease “shall be in accordance with rules adopted by” the State Board of Health. In addition to isolating or quarantining specific individuals, the state board may impose an area quarantine that restricts entrance into or exit from a designated building or physical space, albeit by the “least restrictive means necessary.” The state board must also place signs around the premises of any individual quarantine or isolation or an area quarantine, marking the appropriate boundaries.
If individuals under isolation or quarantine are “financially unable to secure proper care, provisions, or medical attendance,” the local board of health must provide those resources during the period of restriction.
Individuals removed to a separate house or hospital may, at their own expense, employ the health care provider of their choice and provide the supplies necessary for that treatment.
Individuals who violate an order of quarantine or isolation are guilty of a simple misdemeanor.
In Kansas, local health officers share the authority to isolate or quarantine with the state Department of Health and Environment. Local health officers must report the incidence of contagious diseases to the state, and those reports must remain confidential. If local officers neglect to properly isolate or quarantine people infected with contagious diseases, the department “may quarantine any area in which [the disease] may show a tendency to become epidemic.”
Violating a local health officer’s order of quarantine or isolation is punishable by a fine of $25 to $100 for each offense. Violating an order of quarantine or isolation issued by the state Department of Health and Environment is a Class C misdemeanor.
If the local health officer or the state Department of Health and Environment issues an order of isolation or quarantine, the order must specify the identity of the individual or group, the “premises subject to isolation or quarantine,” the date and time at which the restriction begins, the suspected disease causing the outbreak, the factual basis upon which the restriction is justified and the “availability of a hearing to contest the order.”
The order must be provided in writing unless the issuing officer determines that written notice would be impractical because of the number of individuals or the scope of the affected geographic area. In that case the issuing officer is expected to fully inform the relevant individuals “using the best possible means available,” including posting the order in “a conspicuous place in the isolation or quarantine premises.”
Anyone subject to an order of quarantine or isolation may request a hearing in district court to contest the restriction. The request for a hearing does not stay the order. Upon receiving a request for a hearing, the court must conduct a hearing within 72 hours of receipt, unless the issuing officer demonstrates that “extraordinary circumstances” justify an extension of the order and a delay in scheduling the hearing. In considering the officer’s request for an extension, the court must consider the affected individual, the protection of the public health, the severity of the health emergency, and the availability, if necessary, of witnesses and evidence.”
If an individual cannot appear personally before the court, the court may conduct the hearing provided that the individual’s authorized representative is present and the individual is allowed to fully participate through other means.
The court may consolidate individual claims into group claims if “the number of individuals involved or affected is so large as to render individual participation impractical, there are questions of law or fact common to the individual claims or rights to be determined, the group claims or rights to be determined are typical of the affected individual's claims or rights, and the entire group will be adequately represented in the consolidation.”
The court must appoint counsel to all individuals or groups who are not otherwise represented.
The court must grant the request for relief unless it determines that the restriction is “necessary and reasonable to prevent or reduce the spread of the disease.” It may consider the “means of transmission, the degree of contagion, and, to the extent possible, the degree of public exposure to the disease.”
A court order authorizing the isolation or quarantine must identify the relevant individuals or group, specific the factual findings justifying the order, and be distributed in writing, unless it is impractical to do so. If it is impractical to do so, it must use the best possible means necessary to alert the relevant individuals. The court order cannot last longer than 30 days.
Public and private employers are prohibited from firing an employee only because the employee or an immediate family member is under an order of quarantine or isolation. Employers that do so are guilty of a Class C misdemeanor.
Kentucky’s quarantine and isolation regime is not well defined. Section 214.020 of the state’s code gives the state Cabinet for Health and Human Services the power to establish and maintain quarantine and isolation when it believes “that there is a probability that any infectious or contagious disease will invade this state.”
City-county boards of health in the state also have the power to quarantine, but the statute that endows that authority generically covers a wide array of public health responsibilities.
A 1911 Kentucky Court of Appeals case, Allison v. Cash, affirmed the quarantine power of city-county boards of health. A local business owner sued the Lyon County Board of Health for closing and fumigating her shop in Eddyville, which they deemed necessary after she brought her son to the premises from Kuttawa, a city that was experiencing a smallpox outbreak. The business owner had obeyed the health board’s order that she and her son leave the city and quarantine themselves, but she refused to close her store upon leaving; the health board disinfected the shop and then closed it for four weeks, ruining her merchandise in the process.
The court denied the business owner’s suit and upheld the statutory power of the Lyon County Board of Health to quarantine the shop owner and to close her shop, holding that both the state and county boards of health were “invested by law with broad powers for the protection and safety of the public health.”
A recent case in which a Kentucky man who tested positive for COVID-19 but initially refused treatment illustrates how state and local authorities are implementing their quarantine powers in practice. The man resided in Nelson County, Kentucky, where the county judge-executive declared a state of emergency that, according to local news reports, “allowed him to impose a curfew and quarantine on the man and other residents in his home.” The county attorney told reporters that the county requested and received a confidential circuit court order concerning one of the residents of the man’s house but did not provide further details.
Louisiana law dictates that the state health officer and the state Department of Health have exclusive “jurisdiction, control, and authority to isolate or quarantine for the care and control of communicable disease within the state.”
If any segment of the state reports an incidence of a communicable disease that threatens to spread throughout the state, the state health officer must issue a proclamation summarizing the situation and order the infected “parish or municipality or the infected portion thereof” quarantined. The state health officer must also order all local health officers to “quarantine against the locality” and establish and promulgate rules and regulations governing any interactions with that locality.
The state health officer also has the authority to order quarantines over much smaller geographic areas, including individual rooms in a home or apartments in a building.
The state health officer also has the power to bar any individuals from entering the “infected portion of the state” if he or she deems that their introduction “would increase the prevalence of the disease.”
Any individual who has been or is suspected of having been exposed to a communicable disease must either submit to medical examination and testing or be placed in isolation or quarantine as long as their status “remains undetermined.”
Violating an order of isolation or quarantine is punishable by a fine of $50 to $100 and imprisonment of up to two years.
Beyond a criminal prosecution, if the local state health officer or the Louisiana Department of Health believes that an individual has violated the state sanitary code and will facilitate the spread of an epidemic or otherwise poses an “imminent menace to the public health,” they may request that the local district attorney petition the district court to restrain that individual by a permanent or temporary injunction. The district court may grant that petition if it finds that there is cause to do so.
Under Title 22 Section 802, Maine grants the Department of Health and Human Services the authority to designate and classify communicable diseases; establish reporting and surveillance requirements; investigate cases and epidemics of communicable diseases; and establish procedures for the control, detection and treatment of such diseases, including public immunization and contact notification programs.
The department has authority to declare a health emergency in the event of an actual or threatened epidemic and to adopt emergency rules for the protection of public health. Such rules may include procedures for isolating and treating infected persons, disinfecting or destroying contaminated property and establishing temporary facilities for treating infected or exposed persons. All agents of the department, as well as local health officers and law enforcement, are authorized to enforce the department’s rules and the department may order any person who neglects or violates any of these rules to cease and desist, and may seek an injunction or civil fine against the person if they continue to refuse to obey the order.
The department has authority to establish an investigative team and procedures to pursue detection and treatment of infected individuals and may issue subpoenas requiring persons to disclose information or records relevant to such investigation to the department. If, based on epidemiologic evidence or medical evaluation, the department finds probable cause that a person has a communicable disease but that person is unwilling to submit to a physical exam made available to the department, then the department may petition the district court for an order directing the exam or releasing the results. Upon such petition, the district court will hold a hearing and, if the court finds by a preponderance of the evidence that there is probable cause to believe the person has the communicable disease and that the person has willfully refused the department’s request, then the court shall order examination or release of such results.
The department can also petition for an immediate custody order in the event that the person presents a “clear and immediate public health threat,” demonstrated by clear and convincing evidence. A hearing on such a petition must be held within 72 hours, and notice of the hearing must be served at least 24 hours before it occurs. The notice must also inform the person of their right to appear at the hearing, present or cross examine witnesses and right to counsel. These immediate custody orders may also be issued ex parte if an affidavit sets forth the reason why prior notice could not or should not be given. An emergency hold may not continue longer than five days after the hearing, unless the court grants an order of commitment.
Upon clear and convincing evidence of a public health threat, the court may issue orders for treatment, education or commitment, but any such order must be “by the least restrictive measures necessary to effectively protect the public health.” All such orders are appealable to the superior court. No treatment order may last more than 180 days without further review by the court and no commitment order may last longer than the original 30 days without an order to continue the confinement. A committed person may also request the appointment of a medical review board to determine if the patient’s medical status will permit termination of the order of commitment. Finally, if a person violates a commitment order, the hospital or physician must report the violation to the department and, upon applicable by the department, the district or superior court must issue an arrest warrant.
Upon reasonable grounds to believe there exists a public health threat, an authorized agent of the department may enter any public or private place, building or common carrier in order to investigate. The department may order any person attending or working in a school or day care not to attend during an actual or imminent outbreak of a communicable disease or may order any infected person not to attend if they pose a public health threat. The department may designate facilities including hospitals, private homes or other institutions, though not a jail or correctional facility, to confine and treat infected persons.
The governor may also declare an extreme public health emergency under both Title 22 Section 802 and Title 37 Section 742. In an extreme public health emergency, the department has additional powers to take persons into custody or order prescribed care of persons without court order if the department has reasonable cause to believe the person has been exposed to the communicable disease, there is no less restrictive means to protect the public, and the delay in seeking a court order would pose an imminent risk to the person or significant medical risk of transmission. A hearing must be held upon such order within 48 hours of the order, notice must be served within a reasonable time before the hearing and the order may not exceed 30 days in duration without further review by the court. Any order to continue the order must be upon an additional petition and hearing, and any of these orders is appealable to the Supreme Judicial Court. Persons who can demonstrate a “sincere religious or conscientious objection to the examination, vaccination, medical or treatment” are exempted from such an order.
In Maryland, the state Department of Public Health has the power to investigate and prevent the spread of dangerous diseases, including the authority to quarantine or isolate. Moreover, if a mentally competent adult refuses treatment for a dangerous disease, the department may order that person into isolation or quarantine until they are no longer deemed a danger to public health.
The department may require a health care provider to report information on individuals with “specified illnesses or symptoms,” diagnostic and laboratory results relating to “diseases caused by deadly agents,” statistical trends relevant to “potential disease outbreaks,” information necessary for contact tracing exposed individuals and other data deemed by the department to have “epidemiological significance in detecting catastrophic health emergencies.” Any information reported to the department must remain confidential.
If a health care facility does not comply with these requirements, the department may impose a fine of up to $3,000 for each offense. If a health care practitioner fails to comply with this requirement, the department may request that the “appropriate licensing board” discipline the practitioner, including placing the practitioner on probation, suspending their license or certificate, or imposing a fine of up to $3,000 for each offense. But a health care provider acting in good faith is immune from any civil or criminal penalties—they must act with “willful misconduct” in order to be liable.
When the department determines that a quarantine or isolation is necessary, it must inform the relevant individual(s) of the premises subject to isolation or quarantine, the suspected cause of the outbreak and the basis for the restriction. It also must provide the individuals with a hearing to contest the directive. If the department determines that individual notification by written notice is impractical because of the number of individuals or the scope of the affected geographic area, the department may post it in a “conspicuous place in the isolation or quarantine premises.”
Anyone subject to a quarantine or isolation order may request a hearing in a state circuit court to contest the restriction, although the request for the hearing does not stay the restriction directive. Upon receipt of the request for a hearing, the court must conduct the hearing within three days but may extend that timeline if the department or another designated official demonstrates that extraordinary circumstances justify the extension. If the individual in question does not have counsel, the court must appoint an attorney to represent them.
When considering an individual’s request for relief, the court must grant that request unless it determines that the restriction is “necessary and reasonable to prevent or reduce the spread of the disease or outbreak.”
The reviewing court may order the consolidation of individual claims if the group at issue is so large that individual representation would be impractical, if there are questions of fact or law common to each individual claim, if the group’s claims are typical of the individual’s claims, and if the entire group “will be adequately represented in the consolidation.”
In issuing an order authorizing isolation or quarantine, the court must identify the affected individuals “by name or shared characteristics” and specify its factual findings that justify the restriction. Any court order authorizing isolation or quarantine is effective for no more than 30 days. The Department of Public Health or a “designated official” may move to continue the restriction for “subsequent 30-day periods,” which are again subject to the court’s approval.
The department has the right to enter and inspect private property in order to determine the presence or cause of a dangerous disease. Additionally, it may order law enforcement officers to assist in the execution of a quarantine or isolation order.
Maryland law dictates that no employer—public or private—may terminate employees who are subject to an order of quarantine or isolation.
Any person who violates any quarantine or isolation order is guilty of a misdemeanor punishable by up to a year in prison and a fine of no more than $3,000.
Massachusetts provides two sets of regulations regarding quarantine or isolation of persons infected with contagious disease. The regulatory schemes are triggered by discovery of contagious diseases listed by statute.
In the event of an outbreak of a disease dangerous to the public health, Massachusetts provides authority for the board of health of a town to confine any infected persons in their homes or to remove them to a hospital if they cannot be properly isolated at home. Diseases deemed dangerous to public health are defined by the Massachusetts Department of Public Health. If quarantined at home, any other persons residing there are subject to the board’s regulations, and the board also has authority to remove any persons from the neighborhood if necessary.
A magistrate judge can issue warrants for the removal of any infected persons to a hospital or to take control of buildings and personnel needed to handle the outbreak. There are also numerous provisions regarding warrants authorizing the seizure or destruction of infected property and articles and compensation for such takings. Massachusetts also protects the right of wage earners who are confined in the interest of public health to receive compensation for three-fourths of lost wages from their towns, up to two dollars per working day. The two dollar maximum has not been updated since at least 1938, when the Supreme Judicial Court of Massachusetts interpreted the term “wage earner” in the case of McFadden v. E. Bridgewater.
Any person “who knows or has cause to believe that a person in his family or house is infested with a disease dangerous to the public health” must give notice to the board of health of their town. Violation of these provisions or any rules or regulations promulgated under them can result in fine.
Massachusetts provides more detailed regulation of quarantine procedures under the Code of Massachusetts Regulations for the Department of Public Health regarding Reportable Diseases, Surveillance, and Isolation and Quarantine Requirements. These provisions apply to reported cases or suspected cases of selected diseases listed at Section 300.200(A)-(B). These diseases are required to be reported to either the local health official or the Department of Public Health. This section adopts the guidelines on prevention of transmission of infection published by the U.S. Centers for Disease Control and Prevention.
Before using compulsory measures, the department or the local board of health is instructed to educate individuals regarding the reasons and conditions of quarantine and seek to secure their voluntary compliance. Voluntary quarantines do not require a written or oral order. If voluntary compliance is not achievable, then the department or the local board of health may order quarantine or isolation by a written order or temporarily by oral order followed by a written order within 24 hours. The order must include details regarding the individual, reason and conditions of quarantine or isolation, legal authority, and notice to the individual that he or she may appeal the decision. Either type of order may be appealed by contacting a health official at the telephone number provided to the individual upon order of quarantine or isolation or by petition in superior court. If the person is to be quarantined someplace other than at home, then the department or the local board of health must obtain an order of the superior court within 10 days. The department or the local board of health may also apply to the superior court for orders to enforce any quarantine or isolation that is violated.
Quarantine or isolation must be conducted in the least restrictive setting that complies with the minimum period of quarantine or isolation for that particular disease as described in Section 300.200. There is no time constraint placed on ordered quarantine or isolation beyond that specified within the order, or beyond when the individual no longer poses a serious danger to public health. During quarantine or isolation, the individual is to be monitored regularly to determine if continued confinement is required, the individual is to be provided adequate food, medicine, medical care, and mental health services as needed, and the state is to consider any cultural or religious beliefs or disabilities relevant to the individual’s needs.
Finally, Massachusetts regulations also outline procedures for the isolation or quarantine of people in a geographic area that poses a serious danger to public health. Such orders are also appealable.
In Michigan, the power to issue an order of quarantine or isolation rests with the state Department of Health and Human Services or a local public health officer.
If a representative of the state health department or a local public health officer determines that an individual carries a dangerous disease and is a health threat to others, the official must issue a warning notice to the individual requiring them to cooperate with authorities in an effort to contain the transmission of the disease.
The warning notice may require the individual to undergo medical tests to verify their status as a carrier. Warning notices must be issued in writing, except “in urgent circumstances,” in which case they may be delivered verbally and then followed by a written notice within three days. A warning notice must be specific to an individual and cannot be issued to a group. The warning must state that, unless the individual takes the requested action, the official will seek an order of quarantine or isolation from the local probate court. Finally, the order must inform the individual that they have the right to a hearing.
If the issuing officer “knows or has reasonable grounds to believe” that the individual has not complied with the warning notice, he or she may petition the circuit court for the county of Ingham or the county served by the local health department for an order to isolate or quarantine the individual. The petition must describe the underlying factual background, the individual’s failure to comply with the original warning, the officer’s effort “to alleviate the health threat to others,” the type of relief sought and a request for a court hearing.
Upon receipt of a petition for a hearing, the court must schedule one as soon as possible but no later than 14 days after the filing of the petition. The individual must be served with notice of the hearing no fewer than three days before the hearing. That notice must inform the individual of their right to appear at the hearing, their right to present and cross-examine witnesses, and their right to counsel. If the individual cannot afford counsel, one will be provided for them. To grant the order for quarantine or isolation, the court must find that the public health official proved the allegations set forth in the petition by clear and convincing evidence.
Alternatively, the public health official may present an affidavit to the court stating that the individual is a carrier of a dangerous disease and a health threat to others. In that instance, the court will hold an ex parte proceeding and shall issue a quarantine or isolation order if it finds that “reasonable cause exists to believe that there is a substantial likelihood that the individual is a carrier and a health threat to others.”
An individual temporarily detained under these grounds must be held for no more than 72 hours, excluding the weekend and legal holidays, without a court hearing to determine if the temporary detention should continue. The court may order another temporary detention of the individual if it finds that, by a preponderance of the evidence, the individual would “pose a health threat to others if released.” An order of continued temporary detention must be for no more than five days, unless the public health official files a petition for a hearing, in which case the temporary detention must continue until the hearing.
The cost of implementing the quarantine or isolation order must be paid by the individual unless the court finds that the individual is unable to pay for all or part of it. If so, then the state must pay the costs that the individual cannot cover.
The individual may appeal the court order to the Michigan Court of Appeals.
The Minnesota Department of Health has the authority to quarantine or isolate individuals infected communicable diseases.
The department, or a delegated community health board, may isolate or quarantine an infected individual before a hearing through two potential avenues. First, it can obtain a written, ex parte order authorizing the isolation or quarantine from the District Court of Ramsey County, the county where the individual is located or a county adjoining the county where the individual is located. The department can present the evidence supporting the application for restriction by telephone or videoconference.
The reviewing court must grant the order if it finds that probable cause exists to warrant isolation or quarantine in order to protect the public health. The court’s order must state the factual basis for the restriction, and it must inform the individual that they have a right to a court hearing as well as a right to be represented by counsel during any future court proceeding. If the department determines that such a written notice is impractical because of the number of individuals or the scope of the affected geographic area, the department may post it in a “conspicuous place” in the restricted location or in a location nearby where the individuals in question will have access.
No individuals may be restricted pursuant to an ex parte order for longer than 21 days without a court hearing, but they may request one at any time before the expiration of the order.
The second method by which the department may isolate or quarantine an individual or group is through a temporary hold. The department is authorized to issue a temporary hold if the delay of obtaining an ex parte order would “significantly jeopardize” the ability of public health authorities to prevent the spread of the dangerous communicable disease. The directive authorizing the temporary hold must specify the known incubation or communicability of the disease, and it will remain in effect for the period specified by the department unless amended by the department or superseded by a court order.
If it has issued a temporary hold, the department must provide the relevant individual or group with notice that they have the right to request a court hearing and a right to be represented by counsel during all future proceedings. Again, if the department determines that such a written notice is impractical because of the number of individuals or the scope of the affected geographic area, the department may post it in a “conspicuous place” in the restricted location or in a location nearby where the individuals in question will have access.
Law enforcement officers are authorized to apprehend, transport, quarantine or isolate the individual subject to a court order or temporary hold.
Immediately after authorizing a temporary hold, the department must apply for an ex parte order from the court and the court must rule on that application within 24 hours of receiving it. If the court does not issue an ex parte order within 36 hours of receiving the application, the temporary hold expires. Simultaneous with applying for the ex parte order, the department must notify the “governor, the majority and minority leaders of the senate, the speaker and majority and minority leaders of the house of representatives, and the chairs and the ranking minority members of the senate and house of representatives committees having jurisdiction over health policy that a directive for a temporary hold has been issued under this subdivision.”
If an individual subject to an ex parte order or a temporary hold petitions to contest their restriction, the court must hold a hearing within 72 hours of the date of the filing. A petition for a hearing “does not stay the order of isolation or quarantine.” At the hearing, the department “must show by clear and convincing evidence” that the restriction is “warranted to protect the public health.”
If the department wants to extend a court order for isolation or quarantine, it must request such an extension from the court. The individual or group at issue must be notified of the approaching hearing at least three days before it takes place. Again, if the department determines that such a written notice is impractical because of the number of individuals or the scope of the affected geographic area, the department may post it in a “conspicuous place” in the restricted location or in a location nearby where the individuals in question will have access.
The notice must inform the individual of the time and location of the hearing, the factual basis behind the department’s request for an extension, the individual’s right to appear and their right to counsel. The court may order the continued isolation or quarantine if it finds “by clear and convincing evidence” that the individual or group would “pose an imminent health threat to others” if the restriction was lifted.
The restriction on an individual terminates automatically on the expiration date of the authorizing court order. The department may terminate that order before the expiration date if it determines that the restriction is “no longer necessary to restrict the public.”
Isolation or quarantine must be the least restrictive means necessary to prevent the spread of a communicable or potentially communicable disease to others. The department must monitor the health of the individual “to determine if they require continued” restriction.
If an unauthorized individual enters an area of quarantine or isolation, the department may determine that they also pose a danger to public health and subsequently may be subject to isolation or quarantine according to the state’s due process protections. A family member or health care agent of a restricted individual has the right to choose to enter the area of isolation or quarantine. If they choose to enter the area, the department must allow them to do so, provided that they sign a consent form acknowledging the potential risks. If the family member or health care agent subsequently poses a risk to the public health, they also may be subject to quarantine or isolation in accordance with the same due process protections.
Restricted individuals have the “fundamental right” to refuse treatment, testing, examination, vaccination or other care programs. If an individual does refuse medical care or examination, they may be subject to continued restriction.
Isolated individuals must be confined separately from quarantined individuals. If a quarantined individual subsequently becomes infectious or is reasonably believed to have become infectious, the individual must be isolated in accordance with the state’s due process requirements.
The department must address the needs of the isolated individuals in a “systematic and competent fashion” by providing adequate food, clothing, shelter, medical care and communication with the outside world.
Any individual subject to isolation or quarantine may request a hearing in district court “for remedies regarding the treatment during and the terms and conditions” of their restriction. The court must schedule a hearing that is within seven days of when it received the request, but the request does not alter the original order. If the court finds that the restriction is not in keeping with those requirements it may “fashion remedies appropriate to the circumstances of the emergency.”
Minnesota state law protects any employee who has been subject to an order of quarantine or isolation, or who has taken care of someone subjective to such an order, from being discriminated against or terminated by their employer.
Mississippi also has a loosely defined quarantine and enforcement regime. The State Department of Health has the authority to issue isolation and quarantine orders, but local health departments also have a general power to “to make rules and regulations,” which the state department has interpreted to include isolation orders for individuals suffering from communicable diseases.
If an individual whom the local health board suspects has a communicable disease refuses to be examined by authorities, they must “be prosecuted at law to compel compliance” or to be isolated until the danger of transmission has passed.
An individual who violates a quarantine or isolation order is guilty of a felony and faces a maximum fine of $5,000 and a prison sentence of up to five years.
All law enforcement officers are “authorized and directed” to assist in enforcing such restriction orders.
Health care professionals treating patients with communicable diseases that have been confirmed by blood tests must report those diagnoses to the State Board of Health. Insurance companies who obtain those test results must also report them to the state board. The board will report practicing physicians who fail to report the diagnosis of a dangerous communicable disease and such a failure is grounds for the suspension of the physician’s license. Anyone who is not a licensed physician or in charge of a health care facility and willfully fails to report these results is guilty of a misdemeanor and may be punished with a maximum fine of $500 and no more than 30 days in county jail.
Missouri specifies certain infectious, contagious, communicable or dangerous diseases as immediately reportable to the local health authority or to the Department of Health and Senior Services, including “[i]nstances, clusters, or outbreaks of unusual, novel, and/or emerging diseases or findings not otherwise named in this rule, appearing to be naturally occurring, but posing a substantial risk to public health and/or social and economic stability due to their ease of dissemination or transmittal, associated mortality rates, or the need for special public health actions to control.”
Having received a report of an infectious disease, the local health authority or director of the Department of Health and Senior Services is to investigate, inspect and record their finding and establish and maintain control measures as required, including quarantine, isolation, disinfection, immunization, closure of establishments, and notification to the public and persons exposed. The department is authorized to make and enforce orders to prevent the spread of diseases and the local health authority, director of the department or the director’s designated representatives are instructed to ensure adequate notice is given to exposed individuals and to the public regarding a case or outbreak of such a disease.
The local health authority, the director or designated representative shall require isolation of a patient with a communicable disease, as well as quarantine of contacts, disinfection, or other forms of control procedures as is necessary for the protection of the public health. Any person who leaves an “isolation hospital, or quarantined house or place without the consent of the health officer having jurisdiction, or who evades or breaks quarantine or knowingly conceals a case of contagious, infectious, or communicable disease, or who removes, destroys, obstructs from view, or tears down any quarantine card, cloth or notice posted by the attending physician or by the health officer, or by direction of a proper health officer” is guilty of a Class A misdemeanor.
Physicians and health care practitioners also have duties to provide detailed information regarding proper control measures to patients immediately upon diagnosis of a reportable communicable disease and to provide information and records upon request of the director or a designated representative. All local health authorities are required to forward reports of all designated infectious, contagious, communicable or dangerous diseases to the Missouri Department of Health within 24 hours of receiving such reports. Local public health agencies are to adopt confidentiality policies as stringent as the Missouri Department of Health’s policies for such information and reports. This information is to be used only for investigation, detection and prevention purposes, and is only to be released in statistical aggregate forms, preventing identification of any individuals, physicians or medical facilities.
Anyone infected by or “liable to transmit” a reportable disease is barred from attending school. The local health authority, director or designated representative is empowered to close any public or private school or any other public or private assembly if the closing is necessary to protect the public health; however, only the director or the director’s representative may do so during a statewide pandemic.
Montana law provides little statutory guidance on what procedures authorities have to follow to quarantine or isolate individuals. The Montana Department of Public Health & Human Services is empowered to impose quarantine and isolation measures to “carry out the purposes of the public health system to protect and promote the public health.” Another statute states that the department “may adopt and enforce quarantine or isolation measures to prevent the spread of communicable disease.”
A regulation provides that if quarantine of contacts is required due to a communicable disease, a local health officer or the department must “institute whatever quarantine measures are necessary to prevent transmission.” The authority must specify in writing the individual that must be quarantined, the quarantine location, “the frequency with which possible or known contacts must be medically observed to determine if physiological signs of the disease are occurring, and the duration of the quarantine.” The authority must also ensure that these contacts are “medically observed as frequently as necessary during the quarantine period.”
Another regulation states that when an agency declares isolation of an individual, it must “supply to the infected person in writing a description of the place of isolation, the length of the isolation period, and the name and title of the person declaring the isolation.”
When an individual is subject to quarantine or isolation due to a communicable disease, the individual may not travel to another location, and authorities may not transport the individual to another location, “without the permission of the local health officers with jurisdiction over the places of departure and arrival.” There is an exception for an individual who is going to be admitted directly to a hospital and both jurisdictions’ local health officers are “satisfied that adequate precautions are taken to prevent dissemination of the disease by the infected person en route to the hospital.”
If an individual does not comply with quarantine measures, the individual is subject to a fine between $10 and $100 after conviction.
A statutory part on “Tuberculosis Control” addresses procedures for the department to request a court order to require treatment or examination of a person “reasonably suspected to have or to have been exposed to tuberculosis” and court-ordered treatment or commitment of an individual who does not comply with an order to submit to a tuberculosis examination. It also addresses procedures for an individual to get released from commitment. All of these provisions appear to be limited to tuberculosis, however.
In Nebraska, the Department of Health and Human Services has supervisory power over all quarantines and quarantine regulations, but local county health boards also have the authority to issue quarantines and other measures to stop the spread of contagious diseases. The chief law enforcement officer of the jurisdiction will be appointed as the quarantine officer for that health board.
When the state issues a quarantine or isolation order, it does so through the office of the director of the Department of Health and Human Services as a directed health measure. To issue such a measure, the director must find that members of the public have been exposed to a dangerous disease and that a directed health measure will effectively prevent or limit the slow of that disease. Additionally, the director must find that one or more of the following factors exist: “a. That the exposure presents a risk of death or serious long-term disabilities to any person; b. That the exposure is wide-spread and poses a significant risk of harm to people in the general population; or c. That there is a particular subset of the population that is more vulnerable to the threat and thus at increased risk.” Finally, the director must find that a delay in imposing the directed health measure would “significantly jeopardize” the state’s ability to prevent the spread of the disease, in which case the director may issue the measure.
Directed health measures may impose restrictions on an individual, a group of people, or the public at large in relation to certain restricted locations and activities. Moreover, the director may order the “temporary seizure or commandeering of personal or real property for public health purposes.”
When determining the “nature, scope, and duration” of the measure, the director must identify the least restrictive practical means of restriction, select a place of restriction that will allow the most freedom of movement and communication with the outside world while still preventing disease transmission, and ensure the restriction lasts no longer than necessary to protect the public health. The director should also consider the best way to separate isolated individuals from quarantined individuals, if possible.
Orders from the director mandating directed health measures are “effective immediately.” In addition to the factual determination underlying the directive, an order imposing isolation or quarantine must contain a host of information, including the factual basis for the isolation, the conditions for termination of the order, duration of the isolation period and the procedure to request a hearing.
Orders to individuals must be delivered “in a manner reasonably calculated to give the individual actual notice,” while orders directed to groups or entire populations “may be disseminated by mass media.”
Copies of all orders must be provided to the chief elected official in the jurisdiction affected by the order.
Any person subject to an order may request a hearing before the director of the Department of Health and Human Services to contest its validity. Upon receiving the request, the department must schedule a hearing no sooner than three days after the request is received but as “soon as reasonably possible under the circumstances.”
At the hearing itself, only the individual and the department may appear unless: “1. One or more additional persons have requested contested case hearings on substantially identical issues; 2. The interests of administrative economy require that the matters be consolidated; and 3. No party would be prejudiced by consolidation.”
Individuals may be represented by counsel at their own expense. Hearings may be conducted via telephone or videoconference. The purpose of a hearing “is to determine if the factual bases for the Order exist and the reasonableness of the ordered measures.”
The director may affirm, reverse or modify the order by a written “Findings of Fact, Conclusions of Law and Order.” Those findings must be released as soon as possible after the hearing.
Individuals or parties that are not satisfied with the director’s ruling may appeal to a district court in accordance with the Nebraska Administrative Procedure Act.
Any individual subject to a restriction may present evidence to the director to demonstrate that the restriction should be amended or lifted, at the sole discretion of the director. If the individual refuses to comply with the order, the department will require local law enforcement and other authorities to assist in enforcing it. Health care providers and other people must report noncompliance by a person subject to the order to the department and local law enforcement.
All attending physicians must report the incidence of any contagious diseases to the local health department. Failure to report may result in conviction of a Class V misdemeanor.
Those reports will be kept confidential, and any willful or malicious disclosure of the confidential information is a Class III misdemeanor.
Nevada provides three statutory sections regarding quarantine and isolation: general provisions, emergency isolation or quarantine and involuntary court-ordered isolation or quarantine.
Health authorities, meaning the district health officer or the state’s Chief Medical Officer or his or her designees, may isolate, quarantine or treat a person or group reasonably believed to be infected with or exposed to a communicable disease. The health authority must provide the person or persons with a document informing them of their rights. These rights include the right to refuse treatment, unless a court issues an order requiring the person to submit to involuntary treatment.
A quarantined or isolated person also has the right to make a “reasonable number of completed telephone calls” as soon as reasonably possible after the isolation or quarantine begins and to possess or use a cell phone or other communication device in order to make and receive calls while in isolation or quarantine. If the person is unconscious or otherwise unable to communicate, the health authority or medical facility must notify the person’s spouse or legal guardian by telephone and certified mail.
Emergency isolation of quarantine of a person for testing, examination, observation or treatment may be ordered upon application to a health authority, by order of the health authority or by voluntary consent of the person or their legal guardian. The health authority is only to accept such an application if it is accompanied by a certificate of another health authority, physician or other health care practitioner stating that they have personally examined the person and concluded that “the person or group of persons has been infected with or exposed to a communicable disease, and that because of the risks of that disease, the person or group of persons is likely an immediate threat to the health of the public.” The health authority’s emergency order will put the person “alleged to and reasonably believed” to be infected with or exposed to a communicable disease into custody and transport them to a medical facility, residence or other safe location. The health authority may also petition the district court to take a person into custody or transport a person pursuant to an involuntary court-ordered isolation or quarantine.
Involuntary quarantine or isolation by an emergency order may not last longer than 72 hours unless the person provides additional voluntary consent, a written petition for an involuntary court-ordered isolation or quarantine is filed with the district court clerk or the status of the person is changed to a voluntary isolation or quarantine. The person has the right to immediately seek an injunction or other process in district court challenging the detention. However, if the governor or Legislature has declared a state of emergency or disaster regarding public health, then the health authority may petition the district court for an order finding a “reasonably foreseeable immediate threat to the health of the public” requiring an extension of the 72 hour period, so long as the petition is made before the expiration of the 72 hour period, is supported by affidavits and the extension is “no longer than the court deems necessary for available governmental resources to investigate, file and prosecute the relevant written petitions of involuntary court-ordered isolation or quarantine.” Within 24 hours of a person’s admission into a medical facility under an emergency isolation or quarantine order, the administrative officer of the facility “shall reasonably attempt” to ascertain the identity and location of the person’s spouse or legal guardian and mail notice of the admission to them.
In order to change the status of a person from voluntary isolation or quarantine to an emergency isolation or quarantine, the medical facility must either receive an order to do so by a health authority or provide an application to a health authority for an emergency isolation or quarantine and the certificate of a health authority or health care practitioner. An emergency isolation or quarantine may not last longer than 48 hours without a written petition filed by a health authority with the district court clerk. The individual may immediately seek an injunction or other process in district court to challenge this detention.
The health authority may also petition the district court for an involuntary court-ordered isolation or quarantine on a non-emergency basis. The petition must be pled in the alternative for both isolation or quarantine, if developing facts so require, and must be accompanied by both a certificate from the health authority, physician or other health care practitioner stating that they have examined the person and concluded they have been infected or exposed, and that the person is likely to be an immediate threat to the public health because of the risks of the disease and a sworn written statement by the health authority that, based on their personal observations of the person, there is a “reasonable factual and medical basis to believe” the person has been infected or exposed and poses a public health risk and that the person refused to submit to voluntary isolation or quarantine, examination, testing or treatment.
A hearing on the petition must be held within five days of receipt. The court will promptly order either at least two physicians or at least one physician and one physician assistant to either examine the person or assess the likelihood that the person has been infected with or exposed to the communicable disease, and to provide the court with a written summary of their findings. To facilitate this examination, the court may order a peace officer to take the person into protective custody and transport them to a safe location for detention under the hearing is held. The person alleged to have been infected or exposed, or any relative or friend litigating on their behalf, is entitled to retain counsel for the hearing and the court will charge the county for fair and reasonable compensation for counsel to any indigent person. The person also has the right to be present by telephonic or video conferencing at the hearing and to testify in his or her own behalf, but not to be physically present in the courtroom if it would likely pose an immediate health threat to others.
If the district court finds that there is clear and convincing evidence that, due to the communicable disease, the person is "likely to be an immediate threat to the health of the public” then the court may order involuntary isolation or quarantine for up to 30 days. After this period, the health authority may petition to renew the detention for periods no longer than 120 days, though the court may order an extension for any period of time if it finds that the person is noncompliant with a court-ordered control measure. The extension petition must set forth specific reasons why further isolation or quarantine is necessary and that the person likely poses an ongoing immediate public health threat and the court must consider alternative courses of control or treatment within the least restrictive appropriate environment.
Finally, a person who refuses to comply with any regulation or provision or to provide any information or perform any duty pursuant to the above statutory provisions may be enjoined by a court. Violation of any provision of the Infectious Disease Chapter is a misdemeanor. The court may also make any order “reasonably necessary to carry out the purpose or intent of any provision of this chapter or to compel compliance with any regulation of the [State] Board [of Health] or order of the health authority relating to the control of a communicable disease.”
As in other states, New Hampshire gives the health commissioner the power to impose isolation or quarantine measures “[w]henever it is necessary to prevent the introduction or spread of communicable diseases within this state or from another state, or to restrict such diseases if introduced, and when such communicable diseases pose a substantial threat to the health and life of the citizenry.” However, the statute provides that any such measure must be the least restrictive means available. In the case of isolating or quarantining an individual, the place of isolation or quarantine must be in the place of the individual’s choosing unless the commissioner finds that location “impractical or unlikely to adequately protect” the public.
As in Georgia, the commissioner must also proceed by written order to impose isolation or quarantine, and the statute provides certain items that must be in the order. Individuals must comply with orders immediately after they are issued. If an individual refuses to cooperate with the order, the commissioner may issue a complaint, which must be “sworn to before a justice of the peace.” The complaint must provide the reasons for the order and the “place or facility” where the individual would be isolated or quarantined. After receiving such an order, “any law enforcement officer shall take such individual into custody and transport the individual to the place or facility where the individual is to be isolated or quarantined.”
If anyone ordered to isolate or quarantine leaves the quarantine location without the commissioner’s permission, the commissioner must petition the superior court for review of the order. Additionally, as in Georgia, an individual has due process protections under N.H. Rev. Stat. § 141-C:14-a. Anyone who has been isolated or quarantined may request a hearing in the superior court to contest the order. The superior court must schedule a hearing and render a decision within 48 hours of the request. If there are health-related exigencies, the court may extend the time period, but the hearing and decision must still take place no later than 120 hours after the request was made.
If individuals file requests for hearings, they may not be examined or treated against their will during that time, though they may be held in isolation or quarantine during the pendency of the court proceeding. If the court does not comply with the time requirements for reaching a decision, the individual must be released.
At the hearing, the commissioner must “prove by clear and convincing evidence that the person poses a threat to public health” and therefore the order is necessary to “alleviate” this threat. Although a person cannot be subject to medical examinations, treatments or immunizations without their consent, they may be “subject to isolation or quarantine for the minimum period necessary to protect the public health, as determined by the court in its decision following the hearing.”
In general, anyone who violates or neglects to comply with the communicable disease provisions is “guilty of a misdemeanor if a natural person, or guilty of a felony if any other person”—though it’s not quite clear what this distinction means.
To stop the spread of disease among individuals, New Jersey law gives the Department of Health and local boards of health the power to “[m]aintain and enforce proper and sufficient quarantine, wherever deemed necessary.” These bodies can also declare when a disease has become epidemic and “[r]emove any person infected with a communicable disease to a suitable place, if in [their] judgment removal is necessary and can be accomplished without any undue risk to the person infected.” If the governor declares a public health emergency, the state Department of Health assumes the supervision of local authorities and the goal is to ensure a “uniform exercise” of public health powers in the state.
N.J. Admin. Code Section 8:57–1.11 fills in some of the details surrounding quarantine and isolation procedures but still gives broad discretion to health authorities. Section (a) provides that when the department or local health officer receives a report of a communicable disease, the department or officer will “establish such isolation or quarantine measures as medically and epidemiologically necessary to prevent or control the spread of the disease” by written order. Section (c) applies to quarantining or isolating individuals; it states that the department or officer may “isolate or quarantine any person who has been exposed to a communicable disease as medically or epidemiologically necessary to prevent the spread of the disease” by written order, though the period of the restriction may “not exceed the period of incubation of the disease.” Additionally, Section (d) provides that if someone is responsible for the “care, custody, or control” of an individual who has a communicable disease, that person must “take all measures necessary to prevent transmission of the disease to other persons.”
There are further regulations under the heading “Management of Tuberculosis.” Those regulations are phrased broadly, however, so it is unclear to what extent they apply to managing other communicable diseases. These regulations include provisions for court-ordered isolation or commitment, noncompliance with court orders and a hearing process.
A 2016 District of New Jersey case addressed New Jersey quarantine law, the claims that an individual can raise regarding quarantine and the process required to quarantine an individual. In Hickox v. Christie, a nurse who was in West Africa treating individuals affected by the Ebola epidemic was placed in quarantine upon her return to the United States at Newark Liberty International Airport. She brought a civil rights suit under 42 U.S.C. § 1983 alleging that her constitutional rights were violated and also alleged common law tort claims. The court granted the motion to dismiss as to the federal constitutional claims, but not as to the state law claims.
Regarding the federal claims, the court found that the officials named as defendants in the lawsuit were entitled to qualified immunity. Discussing quarantine case law, the court found that the case law “authorizes preventive detention” of individuals: “Within broad boundaries, the length of such detention is a judgment call, calling for the application of expertise; there is no bright-line statutory or constitutional rule.”
Although a “restriction can be so arbitrary or overbroad as to be impermissible,” said the court, the facts here did not show arbitrariness or unreasonableness. Accordingly, the court found that the restriction at issue did not “violate[] clearly established law of which a reasonable officer would have been aware.” Analyzing whether the defendants violated the Fourth Amendment, the court found that there was probable cause to believe that Hickox was “exposed” within the meaning of N.J. Admin. Code § 8:57–1.11(c). Turning to whether the defendants violated the Fourteenth Amendment, the court also found that the case law did not show that the defendants should have been on notice that their conduct “violated clearly established principles of substantive and procedural due process.”
The nurse also alleged that the officials committed the torts of false imprisonment and invasion of privacy/false light (this tort amounts to “publicity that unreasonably places the [plaintiff] in a false light before the public). The defendants argued that the court should dismiss the plaintiff’s false imprisonment claim because they should receive immunity under New Jersey’s Tort Claims Act (TCA). The comment accompanying the immunity provision in the TCA states that the statute “declares a specific rule of discretionary immunity for acts or omissions relating to quarantine or other similar measures for the prevention or control of communicable diseases.” The court stated that this is not an absolute immunity—it applies only when officials acted in good faith. Additionally, this immunity is an affirmative defense, and defendants have the burden of pleading and proving it.
The invasion of privacy/false light claim rested on Governor Chris Christie’s statement that the nurse was ill with Ebola and that she could pose a threat to the public. The court determined that further proceedings were necessary to establish the elements of that claim.
Turning back to more general authorities, New Jersey provides for job protection. The statute requires job reinstatement for anyone who was placed in isolation or quarantine pursuant to the health commissioner, whether the individual was working for a public or private employer, unless it was a temporary position. The individual must be reinstated to a position of “like seniority, status and pay” if the individual meets certain statutory requirements. There is an exception for a change of circumstances where it would be “impossible or unreasonable” to reinstate the individual.
A statute last amended in 1918 provides that anyone who violates the statutory health provisions or fails to comply with statutory duties may be fined between $10 and $100 for each offense.
New Jersey also provides that a permit will not be issued for any vessel to land if someone on board has a communicable disease. A permit will not be granted until the vessel, every person, and all cargo on board have been “examined, cleansed, ventilated, and purified, and a quarantine period has been observed.” The Department of Health is authorized to issue regulations or “issue special orders” regarding these measures.
In New Mexico, the state Department of Health has the authority to “establish, maintain, and enforce isolation and quarantine.”
If the department knows or reasonably believes that an individual has been infected or exposed to a “threatening communicable disease” and the person has refused voluntary assessment and observation, the department must petition the district court of the judicial district where the relevant individual resides for an order to isolate or quarantine the person until they are no longer a threat to the public health or until they voluntarily agree to precautionary measures.
Separately, the department may, by public health order, temporarily isolate or quarantine an individual or group if their continued freedom of movement would “significantly jeopardize” the effort to prevent the spread of a communicable disease. In that case, the public health order would expire 24 hours after the restriction began, but the department may petition for a court order that authorizes the continued restriction.
Regardless of whether a public order has been instituted, the department must submit a petition for a court order articulating the factual basis justifying the restriction.
After receiving the petition, the court must immediately grant an ex parte order to isolate or quarantine the individual if there is probable cause from the facts of the petition to believe that they pose a “substantial threat to public health.” The court must also ensure that a copy of the order is served on the individual and that the individual is notified of their right to a hearing, the terms of the restriction, their right to representation and their right to re-petition for termination of the order.
Within five days after granting the order, the court must hold an evidentiary hearing to determine if the order should continue. At the evidentiary hearing, if the department can show by clear and convincing evidence that the person being restricted has not complied or will not comply with appropriate treatment and precautionary measures, the court may continue the restriction. The court must then order a subsequent hearing within 30 days, with that pattern to continue as long as is necessary.
The court must terminate its order if any one of the following occurs: The person is certified by a public health official to no longer pose a risk to the public health, the department can no longer prove at a hearing that the conditions requiring restriction have been met, or exceptional circumstances exist that warrant the termination of the order.
Anyone subject to a court order may petition the court to contest the order itself or the conditions of restriction at any time. Upon the filing of a petition, the court must hold a hearing within five days, but the filing does not stay the court order. At the hearing, the department must offer clear and convincing evidence that the restriction is warranted or that the conditions of restriction comply with the necessary regulations.
All court proceedings must be held on the record but closed to the public.
While isolating or quarantining an individual, the department must ensure that a series of conditions are met, including that the “isolation or quarantine is the least restrictive means necessary” to protect community health; that a restricted person is provided with adequate food, clothing, shelter, sanitation, and comfort; and that the cultural and religious beliefs of the individual or group are maintained to the “extent possible.”
Any restricted individual has the right to refuse medical treatment, but that refusal may subject the individual to continued isolation or quarantine.
To protect the public health, the department may isolate or quarantine any unauthorized person who enters a restricted area. Household or family members of a restricted individual have the right to choose to enter the restricted area, but they must first sign a consent form acknowledging that they understand the potential risks, including that they may be subject to isolation or quarantine as a result.
During the period of isolation or quarantine, no employer may fire the affected individual.
The department may enforce the relevant statutory provisions by imposing a civil administrative penalty of up to $5,000 for each violation of the state code regarding quarantine or isolation.
The New York Public Health Law gives every local board of health and every health officer broad authority to “provide for care and isolation of cases of communicable disease in a hospital or elsewhere when necessary for protection of the public health.” These entities and officials may also quarantine premises, places, and things that are affected and, “if necessary, provide the means for the thorough purification and cleansing of the same.”
When a physician or health officer makes a complaint that an individual has a communicable disease and is “unable or unwilling to conduct himself and to live in such a manner as not to expose members of his family or household or other persons with whom he may be associated to danger of infection,” a health officer can investigate the situation.
If the officer finds that the individual is a “menace,” the officer files a complaint before a magistrate and the individual is brought before the magistrate. After notice and a hearing, if the magistrate finds that the individual is a danger to other people, the magistrate may commit the individual to any hospital or institution established for the purpose of treating communicable diseases.
A New York state trial court determined that the applicable burden of proof for commitment is “clear and convincing evidence,” in a case where a health officer sought to commit an individual to a hospital for tuberculosis. The court compared the case to situations where individuals are detained in mental facilities against their will, where the government must also prove its case by clear and convincing evidence.
During the proceeding to determine commitment, individuals have a constitutional right to counsel because their liberty would be deprived. Additionally, anyone who has been committed to an institution may appeal to a court “for a review of the evidence on which commitment was made.” In a 1917 case, Crayton v. Larabee, in which the plaintiff alleged that she was unlawfully quarantined, the Court of Appeals (the highest court in New York) said that an official could be liable for “[u]nreasonable and arbitrary action or malicious or partial action, or action in excess of his authority, causing injuries.”
If an individual who has been committed to a hospital or institution violates the rules or regulations or is “disorderly,” the chief medical officer of the institution may take the individual before a magistrate. The chief medical officer may accordingly enter a complaint, and after a hearing and “upon sufficient evidence of such disorderly conduct,” the magistrate may commit the individual to a separate facility for no longer than six months.
New York City
The New York City Health Code also gives New York City specific jurisdictional authority over public health. The New York City Department of Health and Mental Hygiene “may take such action as may become necessary to assure the maintenance of public health, the prevention of disease, or the safety of the City and its residents.” The Health Code provides that physicians or those in charge of medical facilities have a duty to isolate cases of contagious diseases, including “severe or novel coronavirus.” If the individual is not hospitalized, the department may order him or her to remain in isolation or quarantine at home or another residence, “under such conditions and for such duration as the Department may specify to prevent transmission of the disease to others.” A mandatory reporting statute also includes suspected or confirmed cases of severe or novel coronavirus under Section 11.03(b)(1), though the statute does not appear to define severe or novel coronavirus.
Under NYC Health Code § 11.31, “acts likely to spread disease” are prohibited—this includes “intentionally or negligently caus[ing] or promot[ing] the spread of disease.” Prohibited acts include failure to comply with isolation or quarantine measures; unnecessary exposure to others, when the individual knows that he or she may have a contagious disease; unnecessary exposure of someone in the individual’s care; or unnecessary exposure of the remains of someone in the individual’s care to other people. An exception is made for vaccines.
The Health Code also provides detailed procedures for the removal or detention of “cases, contacts and carriers who are or may be a danger to public health.” If the department commissioner finds, by clear and convincing evidence, that the
case, contact or carrier, or suspect case, contact or carrier ... may pose an imminent and significant threat to the public health resulting in severe morbidity or high mortality, the Commissioner may order the removal and/or detention of such a person or of a group of such persons by issuing a single order, identifying such persons either by name or by a reasonably specific description of the individuals or group being detained.
The individuals would then be detained at a medical or other designated facility.
North Carolina’s General Statutes Section 130A-145 empowers the State Health Director and a local health director to exercise quarantine and isolation authority. The statute specifies that this authority may only be exercised when and for as long as the “public health is endangered, all other reasonable means for correcting the problem have been exhausted, and no less restrictive alternative exists.”
Quarantine or isolation measures that limit an individual’s freedom of movement must not exceed 30 days. If someone is “substantially affected by that limitation,” the individual may institute an action to review the limitation in superior court in either Wake County (which contains Raleigh and is the second-most populous county in the state) or in the county where the limitation was imposed. The official exercising quarantine or isolation authority is required to give individuals that will be substantially affected “reasonable notice under the circumstances” of this right.
The individual or the individual’s representative may request a hearing, which must be held within 72 hours of the filing of the request, excluding weekend days. There is a right to counsel, and counsel will be appointed if the individual is indigent. The court must reduce or stop the limitation “unless it determines, by the preponderance of the evidence, that the limitation is reasonably necessary to prevent or limit the conveyance of a communicable disease or condition to others.”
If the state or local health authority determines that the 30-day limitation on freedom of movement is not sufficient for public health purposes, it must commence in superior court in that county an “action to obtain an order extending the period of limitation.” If the individual already brought an action, this will be a counterclaim. With an exception for tuberculosis, the court will continue the limitation for no more than 30 days “if it determines, by the preponderance of the evidence, that the limitation is reasonably necessary to prevent or limit the conveyance of a communicable disease or condition to others.”
The order must state how long the limitation will continue and state that the order will automatically terminate “upon written determination by the State Health Director or local health director that the quarantine or isolation is no longer necessary to protect the public health.”
Additionally, if the individual can show “by a preponderance of the evidence that quarantine or isolation was not or is no longer needed for protection of the public health,” the individual may move for reconsideration of the quarantine or isolation extension order. The state and local authorities may also move to continue the order, but for periods not exceeding 30 days.
North Dakota grants authority to local boards of health to immediately examine cases of contagious or infectious disease and to adopt quarantine and sanitary measures “as in its judgment tend to prevent the spread of such disease.” If a state health officer determines that an infected person can be removed to a separate house without danger to the person’s health, then the local board of health may do so. If the person cannot be safely moved, then the board shall make “such quarantine regulations as it deems proper” in their own house and may remove persons in the neighborhood or take other measures deemed necessary to protect the safety of the board’s jurisdiction.
Upon reasonable grounds to believe a person or group is infected with a communicable disease, that they pose a substantial threat to public health, and that confinement is the least restrictive alternative to protect or preserve public health, any state or local health officer may order the person or group into confinement by written directive. The health status of isolated and quarantined persons is to be monitored regularly to determine if they continue to require confinement and they must be immediately released when they pose no substantial risk of transmitting the disease to others. The needs of confined persons must be addressed in a “systematic and competent fashion, including providing adequate food, clothing, shelter, means of communication[,] ... medication, and competent medical care.” Confinement premises must be “maintained in a safe and hygienic manner and be designed to minimize the likelihood of further transmission of infection.”
Confined persons must obey the health officer’s rules and orders and stay within the confinement premises. No person other than those authorized by the state or local health officer may enter a isolation or quarantine premises. Failure to obey either of these regulations is a Class B misdemeanor.
Isolation or quarantine can be undertaken temporarily without notice or for a longer period with notice. A state or local health officer may issue a written directive for temporary isolation or quarantine without notice if delay in imposing the confinement would “significantly jeopardize the health officer’s ability to prevent or limit the transmission” of a contagious disease. The directive must identify the person or persons confined, the premises, date and time, suspected disease, and any decontamination, treatment or prevention measures to be followed. A copy of the directive must be given to the confined person or, if it applies to a group, must be posted in a conspicuous place in the premises. The officer may also use any available mass media to provide notice and information regarding the directive. Within 10 days of issuing the directive, the officer must file a petition with the court in order to authorize continued confinement.
Application to a court for continued isolation or quarantine of an infected person must be made by written petition to the trial court. The petition must specify the same details as the original written directive and also must include a statement of compliance with the conditions and principles of confinement and a statement of the basis upon which confinement is justified in compliance with these provisions. A sworn affidavit of the state or local health officer attesting to the facts asserted in the petition must accompany the petition. Notice must be given to the persons to be confined within 24 hours, along with a copy of the relevant statutory chapter and a statement of the persons’ right to counsel including counsel at public expense for indigent persons. The person must remain in the confinement premises until the health officer who issued the original written directive determines that they no longer pose a substantial threat to public health or a court orders their release.
A hearing must be held on the petition within five days of filing the petition, though the court may continue the hearing for up to 10 days if good cause is shown. Petition for a hearing will not stay the written directive ordering confinement. The person has a right to a hearing in the district court of the county in which they reside, a right to counsel including at public expense if they are indigent and a right to cross-examine witnesses. The confined person, their counsel or representative, and the attorney for the state or local health officer must have access to all records, including hospital records. The court will authorize continued confinement if, by a preponderance of the evidence, it is determined that the person is infected with a communicable disease, poses a substantial threat to public health, and confinement is necessary and the least restrictive alternative to protect and preserve the public health. The burden of proof is on the health officer who ordered confinement. If the petition is granted, then the court may also order the person to follow the state or local health officer’s directives for decontamination, treatment or preventative measures. If the petition is not granted, then the court must order the person’s immediate release.
The person subject to isolation or quarantine order may at any time request the court to terminate or modify the order. The court may then hold a hearing to determine if conditions continue to require confinement. The person may also request that the hearing be closed and that any record, transcript or report relating to these actions be kept confidential, with only deidentified information released to the public. Any party subjected to an isolation or quarantine order by a district court may appeal that order to the supreme court; however, the order of confinement remains in effect while the matter is appealed.
The local boards of health have authority to provide temporary hospitals or other facilities for infected persons. All such hospitals, and any other private homes or places in which contagious or infectious disease exists, are under the local board of health’s control and subject to its regulations. However, the authority to isolate or quarantine infected persons does not alone provide authorization for the state or local health officer to commandeer any hospital or medical facility in whole or in part. The boards may destroy any “bed, bedding, clothing, carpets, or other articles which have been exposed to infection” and may provide reasonable compensation.
Children infected with or residing with a person infected with a contagious or infectious disease may not attend public or private school until permitted to do so by the local board of health’s regulations.
Physicians have a duty to report within 24 hours to the local board of health when any of their patients die of a contagious or infectious disease and to specify the disease.
Violation of any of these provisions, any lawful rule made by the state department of health, any order issued by a state, district, county or municipal health officer, or any quarantine law or regulation is guilty of an infraction.
The Northern Mariana Islands grant authority to quarantine or isolate persons suffering from or exposed to contagious diseases under Section 2148; however, the statute does not specify the authority responsible for making such a determination or the process for imposing or challenging the order. Violation of a quarantine or isolation order, or any provision of the relevant article or regulations issued pursuant thereto is a misdemeanor offense under Section 2150.
The governor has authority under Section 2183 to declare a state of public health emergency after consulting with the necessary public health authority and other experts as necessary, or if the circumstances require immediate action, may do so without such consultation. Under Section 2192, the governor is also to appoint a Public Health Emergency Planning Commission.
The territory also regulates infectious disease under Section 2146 and Section 2147, which prohibit employees in a wide range of industries from attending work if infected or exposed to a communicable disease and authorize the secretary of the Department of Public Health to require immediate closing of establishments and medical examination of employees upon suspicion of communicable disease.
Title 37 Section 3701.13 gives the state Department of Health supervision of all matters relating to the preservation of the life and health of the people and ultimate authority in matters of quarantine and isolation. This same section also gives the state Department of Health the power to “make and enforce orders in local matters or reassign substantive authority for mandatory programs from a general or city health district to another general or city health district when an emergency exists, or when the board of health of a general or city health district has neglected or refused to act with sufficient promptness or efficiency.” Under Section 3701.14 of this same title, the director of health can investigate or make inquiry as to the cause of disease or illness, including contagious, infectious, epidemic, pandemic, or endemic conditions, and take prompt action to control and suppress it. Similarly, Section 3707.34 allows each city or general district’s health board to appoint a health commissioner who may act on behalf of the board by investigating diseases and establishing quarantine.
To assist in the investigation of potentially harmful diseases, Section 3707.06 requires any physician or landlord who knows a person seeking their services and is suffering from a disease dangerous to the public health to inform a municipal or district health commissioner. When a complaint is made or a reasonable belief exists that an infectious or contagious disease is present in a house or other locality, Section 3707.07 allows the board of health of a city or general health district to send its health commissioner to inspect the house. If a disease exists, the board may send the person infected or suspected of being so to a hospital or other place provided for such person, or may restrain him and others exposed within such house or locality, and prohibit ingress and egress from the premises. Section 3707.08 mandates “[n]o person isolated or quarantined by a board shall leave the premises to which he has been restricted without the written permission of such board until released from isolation or quarantine by it in accordance with the rules and regulations of the department.”
Under Section 3707.09, the board of health of a city or general health district has the power to employ as many persons as are necessary to execute its orders and properly guard any house or place containing any person affected with or exposed to a communicable disease declared quarantinable by the municipal or district health board or the Department of Health. The persons employed shall be sworn in as quarantine guards and shall have police powers. However, when an individual or group is placed under quarantine, Section 3707.14 requires the board of health of a city or general health district to provide food; fuel; and all other necessaries of life, including medical attendance, medicine and nurses when necessary.
During an epidemic or threatened epidemic, the board of health of a city or general health district can use Section 3707.04 to “impose a quarantine on vessels, railroads, or other public or private vehicles conveying persons, baggage, or freight, or used for such purpose.” The board can also “make and enforce such rules and regulations as are wise and necessary for the protection of the health of the people of the community or state, but the running of any train or car on any steam or electric railroad, or of steamboats, vessels, or other public conveyances shall not be prohibited.” This section also requires “[a] true copy of such quarantine rules and regulations [to be] immediately furnished ... and no change shall be made except by the order of the [state Department of Health] or the [relevant municipal or district] board to meet a new and sudden emergency.” However, without the State Board of Health’s approval, Section 3707.05 prevents a municipal or district board of health from closing public highways or interfering with public officers not afflicted with or directly exposed to the contagious disease.
In a state of emergency, Section 3707.31 allows a municipal board of health or a health district to seize a “suitable” location and make a “quarantine hospital.” This same section gives exclusive control of that hospital to the relevant municipal board of health or health district. Similarly, Section 3707.32 allows a municipal board of health or a health district to “erect temporary wooden buildings or field hospitals” in order to “isolate or protect persons or freight supposed to be infected.” Section 3707.32 also allows the relevant municipal health board or health district to employ “nurses, physicians, and laborers sufficient to operate [these locations], and sufficient police to guard them.” Under this section, the relevant municipal health board or health district “may also cause the disinfection, renovation, or destruction of bedding, clothing, or other property belonging to corporations or individuals when such action is deemed necessary or a reasonable precaution.” Section 3707.12 allows a board of health of a city or general health district to destroy any infected clothing, bedding or other article that cannot be made safe by disinfection, as long as the owner of the articles is given a receipt and is compensated under Section 3707.13.
If an individual refuses to comply with or disregards a quarantine or quarantine-related order, Section 3707.02 gives state and general district health boards the power to “cause the arrest and prosecution of all persons offending, or perform, by its officers and employees, what the offending parties should have done.” This section also gives defendants the right to be fully apprised of any complaint as well as the right to a fair hearing. Additionally, any person who employs an alien who is not legally present in the United States and has a contagious or infectious disease contracted before or during employment is required by Section 3707.15 to pay the municipal corporation, township or county in which the alien is employed any expense caused by the contagious or infectious disease.
The governor of Oklahoma or the legislature can declare a state of emergency if an emergency or disaster has occurred or is anticipated in the immediate future. Once an emergency is declared, Title 63, Section 683.9 gives the governor the following emergency powers: regulatory control over all essential resources of the state, directly or through the boards, agencies, and offices; the ability to determine priorities of such resources and allocate such resources as the governor may deem necessary in cooperation with the political subdivisions of the state, the federal government or other states; direct operational control of any or all emergency management forces and helpers in the state; and “such other functions, powers, and duties as are necessary to promote and secure the safety and protection of the civilian population.”
Under Section 684.28, a state of emergency also allows the State Department of Health to limit, restrict or otherwise regulate the duration of practice by volunteer health practitioners, the geographic areas in which volunteer health practitioners may practice, the types of volunteer health practitioners who may practice, and any other matters necessary to coordinate effectively the provision of health or veterinary services during the emergency.
Section 1-502 also gives the Oklahoma State Board of Health the power to adopt such rules and regulations, not inconsistent with law, as it deems necessary to aid in the prevention and control of communicable disease. Specifically, Section 1-504 provides that:
Whenever a local health officer determines or suspects that a person has been exposed to and may be incubating a communicable disease of public health concern, the local health officer may impose a quarantine [or isolation] upon such person and require such person to remain out of public contact and in the place or premises where such person usually stays. Notice thereof shall be given in accordance with the rules and regulations of the State Board of Health. It shall be unlawful for such person, or any other person, to violate the terms or conditions of the quarantine.
Section 1-507 also adds “No person having a communicable disease shall be permitted to attend a private or public school, and it shall be the duty of the parent or guardian of any such person, and the teacher of such person, to exclude from the school such person until the expiration of the period of isolation or quarantine ordered for the case, or until permission to do so shall have been given by the local health officer.”
Separately, according to subsection (C) of Section 1-504, Oklahoma district courts can grant injunctive relief, including temporary injunctions and temporary restraining orders, to compel compliance with quarantine or isolation orders issued by local health officers. Finally, any person who leaves quarantined grounds or willfully violates any quarantine law or regulation, is guilty of a misdemeanor under Title 21, Section 1195. Additionally, under Section 1-503, “[f]ailure or refusal to report diseases as required by the Board shall constitute a misdemeanor.”
Oregon’s isolation and quarantine processes employ many of the same requirements as Washington state. Oregon provides a process for a temporary order for quarantine or isolation by emergency order or ex parte proceeding, as well as a process for a normal court proceeding for a longer term order.
Under Section 433.121 of Oregon’s Revised Statutes, the public health director or a local public health administrator may petition the circuit court for a written ex parte order of isolation or quarantine against an individual. They may also issue an emergency administrative order of isolation or quarantine if there is probable cause to believe the individual “requires immediate detention in order to avoid a clear and immediate danger to others” and that the petition process is not a possibility because of safety considerations.
The administrative order in question must identify the individual and the location of confinement; describe the “reasonable efforts made to obtain voluntary compliance” or why such efforts were not possible and would have created a “risk of serious harm to others”; provide justification for the confinement, including information regarding the suspected disease and medical basis for confinement; and include a statement of compliance with the conditions and principles of isolation or quarantine, which the public health director or local public health administrator are obliged to maintain under Section 433.128.
If the state public health director or local public health administrator decides instead to petition the circuit court, the petition and the court order must include the same information as the administrative order. The director or local administrator must make reasonable efforts to serve the petition on the individual before filing, but there is no requirement to provide prior notice of the ex parte proceeding.
Whether the isolation or quarantine is ordered by administrative order or ex parte court order, the government must serve the individual with written notice and a copy of the order within 12 hours of issuance—or, if there are too many individuals for personal service to be practicable, the notice and order must be posted in a conspicuous place. The notice must inform the subjects of their right to counsel and how to invoke it; the conditions and principles of isolation and quarantine as defined by Section 433.128; the right to petition the circuit court for release or remedy for breach of these conditions; procedures for filing such petitions; and sanctions that may be imposed for violation of the order.
Either of these types of orders must last no longer than 72 hours unless the public health director or a local public health administrator petitions the circuit court for an order pursuant to Section 433.123. The director or administrator may petition the court either for a new order for isolation or quarantine, or for a continuation of an existing isolation or quarantine, for up to 60 days. If there is substantial medical evidence that the disease cannot be rendered noninfectious within 60 days, then the court may order confinement up to 180 days. If, following a hearing, the court finds that “extraordinary circumstances exist and that the person or group of persons subject to isolation or quarantine continues to pose a serious threat to the health and safety of others if detention is not continued,” then the court may order a period of confinement longer than 180 days.
The petition must include the same categories of information as in Section 433.121, and service of the petition and notice is also required under the same specifications as the earlier order. The statute instructs that, if the petition sought is for continued confinement of a person already detained by an emergency order or ex parte order, “the court shall issue an order extending the isolation or quarantine order until the court holds a hearing.”
The hearing must be held within 72 hours of the petition’s filing, though the court may grant a continuance in extraordinary circumstances and for good cause. The person affected may consent to the continuance of the hearing and also may waive the hearing entirely. The psychotherapist-patient, physician-patient and nurse-patient privileges provided for by Oregon’s Evidence Code Rules 504, 504-1 and 504-2 do not apply in this hearing, though any information that would ordinarily be subject to these privileges will not be disclosed to the public. The court must grant the petition for confinement or continuation of existing confinement if it finds by clear and convincing evidence that “isolation or quarantine is necessary to prevent a serious risk to the health and safety of others.”
Violation of a court order imposed under either Sections 433.121 or 433.123 may result in contempt proceedings. Section 433.128 regulates the conditions of and principles for isolation or quarantine, including that it must be “by the least restrictive means necessary to prevent the spread of a communicable disease or possibly communicable disease to others” and “may include, but is not limited to, confinement to private homes or other public or private premises.” Like Washington state, Oregon requires the state government to provide “adequate food, medication, competent medical care, clothing, shelter and means of communication” and to consider the cultural and religious beliefs of the person, including protecting “the right of any person to rely exclusively on spiritual means to treat a communicable disease or possibly communicable disease.” The person quarantined is to pay for any expenses incurred, but if the person is unable to pay, the Oregon Health Authority may provide general and medical assistance on the basis of need pursuant to Section 433.140.
Oregon also provides process for the public health director or local public health administrator to petition the circuit court to isolate contaminated property, which shall be granted if the court finds by clear and convincing evidence that “isolation of property contaminated with a toxic substance is necessary to prevent a serious risk to the health and safety of others.”
Persons subject to any isolation or quarantine order have a right to legal counsel, including appointed counsel if they cannot afford counsel, and any waiver of the right to counsel must be made “expressly, knowingly and intelligently.” Any person subject to isolation or quarantine may apply to the circuit court for an order to show cause why they should not be released or for remedies for breach of conditions. The court may grant these applications if it finds “by clear and convincing evidence” that the person no longer poses a serious risk to the health and safety of others or that the person is not being held in accordance with the conditions of isolation or quarantine.
State and local law enforcement must assist the public health director or local administrator in enforcing orders issued under these provisions. Finally, any city or municipality may establish a quarantine hospital pursuant to Section 433.150. When a “great emergency exists,” the board of health may temporarily seize and occupy “any suitable vacant house or building within its jurisdiction” for use as a quarantine hospital and due compensation will be owed to the owner.
Title 28 Section 27.60 gives the State Department of Health and local health authorities the power to isolate or quarantine a person with a communicable disease or infection when necessary to protect the public from the spread of infectious agents. Under this section, local and state health agencies have the same quarantine and isolation authorities as long as the local agency is a local morbidity reporting office (LMRO). If the local agency is not a LMRO, Sections 27.61 and 27.65 state that non-LMRO officers must receive approval from the State Department of Health before exercising quarantine authority. Both Sections 27.61 and 27.65 also stipulate that the subject or subjects of an isolation or quarantine regularly receive medical observation and have appropriate living quarters. Additionally, the department or local health officer of the LMRO can determine which contacts should be quarantined, specify the place to which they shall be quarantined, and issue appropriate instructions.
Whenever the State Department of Health or a local health authority has reasonable grounds to suspect a person of being infected with a communicable disease but lacks evidence confirming this, Section 27.81 allows the department or the local health authority may require the person to undergo a medical examination and any other approved diagnostic procedure to determine whether or not the person is infected or is a carrier.
If an individual refuses to be examined or treated, Sections 27.82 and 27.87 state that the department or the local health authority may direct the person to be quarantined until it is determined that the person does not pose a threat to public health.
Section 27.82 provides that if a person refuses to take a test, the department or local health authority may file a petition in the court of common pleas of the county in which the person is present. Upon the filing of the petition, the court shall, within 24 hours, hold a hearing to ascertain whether the person has refused to submit to an examination to determine whether the person is infected with the suspected disease causing organism, or that the person is a carrier. Upon a finding that the person has refused to submit to an examination and that there is no valid reason for the person to do so, the court may forthwith order the person to submit to the examination. If the state’s petition has a certificate from a physician, Section 27.82(c) requires a court to view the certificate as prima facie evidence that the person named is suspected of being infected.
Once a court orders a test, Section 27.83 allows the person ordered to take the test to choose which physician performs the test as long as that person pays. The examination must include an appropriate physical examination and laboratory tests performed in a clinical laboratory approved by the State Department of Health. The test’s results should be reported to the local health authority or the Department of Health.
Section 27.87 states that the state Department of Health or the local health authority, if the agency determines the action advances public health interests, can order the person to be isolated in an appropriate institution for safekeeping and treatment until the disease has been rendered noncommunicable. If a person refuses to comply with a quarantine order, the department or a local health authority may file a petition in the court of common pleas of the county in which the person is present to commit the person to an appropriate institution designated by the department or by the local health authority for safekeeping and treatment. Upon the filing of a petition, the court shall hold a hearing within 24 hours after service of a copy to the respondent.
Under Section 27.68, the state Department of Health or a local health authority can end a state of quarantine when either agency determines the individual no longer presents a public health threat.
Puerto Rico law gives the secretary of health the power to prescribe rules and regulations “[f]or the purpose of preventing and suppressing infectious, contagious or epidemic diseases.” The secretary is also responsible for regulations for “reporting, isolating, and treating infectious or contagious diseases.” However, the secretary is not responsible for “maritime quarantine services.”
The secretary has the power to remove an individual “sick with a quarantinable disease” or with any other “rapidly spreading, contagious or infectious disease.” The statutes do not appear to provide a definition of what constitutes a “quarantinable disease,” though there is a definition for “epidemic diseases.” The secretary can designate places for such removal and have control over public hospitals to treat these cases. If it is necessary, the secretary may use other buildings as provisional hospitals. A separate statute also provides that private property may be taken for use as a quarantine station. When individuals cannot afford the cost of being admitted to a hospital, or if it is “necessary to take care of them in the interests of the public health,” the secretary may order that all sick individuals removed to hospitals are treated.
An individual infected with a “quarantinable or other rapidly spreading, contagious or infectious disease” may not be removed from a vessel or any other place designated for isolation and treatment, unless the secretary or official in charge of the vessel or place issues a written permit. To carry out these duties, the secretary or a Department of Health physician may enter private properties and homes at any time for inspection and examination of the premises.
If there is an epidemic that “threatens the health of the Commonwealth,” the secretary is empowered to “take such measures as he may deem necessary to combat” the epidemic. With the governor’s approval, the secretary may “incur such expenses as may be necessary,” which are charged to a statutorily created Commonwealth Emergency Fund.
When the governor declares that an epidemic exists in one or more municipalities by proclamation, the secretary must immediately “take charge of the municipal sanitation” in the affected municipalities. If the secretary recommends it, the governor “may suspend any Commonwealth or municipal officer or employee who may be negligent in municipalities affected by any epidemic.” This suspension may last the entire time that the epidemic does.
As soon as the epidemic is “extinguished,” the governor, on the secretary’s recommendation, must officially declare this to be the case. The legal effects of the described powers activated pursuant to the epidemic declaration will cease.
The secretary, medical inspectors, health officers and their assistants have the power to arrest individuals who violate the sanitary law or regulations, and they must deliver them “as soon as practicable to the nearest police officer.” It is a misdemeanor for individuals to violate the provisions of P.R. Laws §§ 171–190, which deal with measures to combat epidemic diseases, rules for preventing contagious or epidemic diseases and regulations for “reporting, isolating, and treating infectious or contagious diseases.” Individuals are subject to a sentence of up to six months, a fine up to $5,000, or both. However, a first time offender is liable for an administrative fine of up to $5,000. If the individual violates the provisions again within one year, the fine may be raised up to $10,000.
Rhode Island has fewer provisions governing quarantine and isolation procedures. Once again, the state’s health department has broad authority; however, the regulatory scheme incorporates a few procedural protections for persons suspected of infection.
Under Rhode Island General Laws Section 23-8-4, the state director of health, as well as authorized agents, has authority to order confinement by quarantine or isolation, or by less restrictive intervention treatment such as immunization or treatment, upon a determination that “a threat to the public health exists because any person is suffering, or appears to be suffering, from a communicable disease.” Section 23-8-4.1 grants the state’s Department of Health the power to examine any person reasonably suspected of having a communicable disease; however, the provision also grants individuals the right to have their own physician present at the examination, at their own expense.
Violation of an order of confinement, or violation of compliance regulations by transportation agencies, is punishable by a fine or imprisonment.
Persons subject to quarantine have a right to petition for relief at any time, including petition alleging that compliance with treatment is possible by less restrictive means. Additionally, Rhode Island emphasizes that its quarantine provisions do not in any way restrict the right of a person “unable or unwilling for reasons of health, religion, or conscience to undergo immunization or treatment from choosing to submit to quarantine or isolation as an alternative.”
The governor of Rhode Island has the power to proclaim a general quarantine of the whole state or a portion of the state. Rhode Island also has a detailed set of regulations regarding the quarantining of vessels.
The South Carolina State Department of Health and Environmental Control receives its authority from Title 44 Section 44-1-20. Under this section, the State Department of Health is supervised by a board of eight members, one from each congressional district, and one from the state at large to be appointed by the governor, upon the advice and consent of the state senate. Section 44-1-80 gives the State Board of Health and Environmental Control or its designated agents the power to investigate the causes of communicable or epidemic diseases. Additionally, the State Board of Health “must enforce or prescribe preventive measures to suppress or prevent the spread of these diseases by proper quarantine ... to protect the citizens of the State.” Section 44-1-140 also allows the State Department of Health to make separate orders and rules to meet any emergency not provided for by general rules and regulations, to protect the public from dangerous health and communicable, contagious and infectious diseases.
Under Section 44-1-90, the State Board of Health or its designated agents have the power to visit cities, towns, villages or localities where disease is prevalent or threatened; investigate and advise with the local authorities or persons as to such measures as may tend to prevent the spread of disease or to remove or abate causes that may tend to cause or intensify disease; and advise, when practicable or possible, as to measures of sanitation or hygiene. Additionally, Section 44-1-100 requires all state and local law enforcement to carry out and obey the State Department of Health’s orders. This includes enforcing all restrictive measures and quarantine regulations. Specifically, Section 44-4-530(D)(4) provides “public safety authority and other law enforcement officers may arrest, isolate, or quarantine an individual who is acting in violation of an isolation or quarantine order after the order is given.” To help carry out these orders, the public safety authority may request assistance from the South Carolina National Guard.
During a state of emergency, Section 44-4-510 allows the State Department of Health to “perform voluntary physical examinations or tests as necessary for the diagnosis or treatment of individuals.” This same section provides that the State Department of Health can isolate or quarantine any person who has been exposed to or is infected with a contagious or possibly contagious disease or otherwise poses a danger to public health and refuses physical examination or testing. If a person is unable or unwilling for any reason (including, but not limited to, health, religion or conscience) to undergo vaccination or treatment, Section 44-4-520 permits the State Department of Health to isolate or quarantine that individual.
When the State Department of Health isolates or quarantines an individual, Section 44-4-530 requires that the quarantine or isolation be the least restrictive means necessary to prevent the spread of a contagious or possibly contagious disease to others. Additionally, this section states that “the needs of persons isolated and quarantined must be addressed in a systematic and competent fashion including, but not limited to, providing adequate food, clothing, shelter, means of communication with those in isolation or quarantine and outside these settings, medication, and competent medical care.” Similarly, the premises used for isolation and quarantine must be maintained in a safe and hygienic manner and be designed to minimize the likelihood of further transmission of infection or other harms to persons isolated or quarantined. The health status of isolated and quarantined individuals must be monitored regularly to determine if they require isolation or quarantine; and isolated and quarantined individuals must be immediately released when they pose no substantial risk of transmitting a contagious or possibly contagious disease to others. Finally, “an employer may not fire, demote, or otherwise discriminate against an employee complying with an isolation or quarantine order.”
Section 44-4-540 outlines the procedures the State Department of Health must undertake in order to lawfully quarantine or isolate an individual or group. Specifically, the State Department of Health may “temporarily isolate or quarantine an individual or groups of individuals through an emergency order signed by the commissioner or his designee, if delay in imposing the isolation or quarantine would significantly jeopardize [the department’s] ability to prevent or limit the transmission of a contagious or possibly contagious disease to others.” This emergency order must specify:
The identity of the individual or groups of individuals subject to isolation or quarantine;
The premises subject to isolation or quarantine;
The date and time at which isolation or quarantine commences; and,
The suspected contagious disease.
Within 10 days after issuing the emergency order, the State Department of Health must file a petition for a court order authorizing the continued isolation or quarantine of the isolated or quarantined individual or groups of individuals. After a petition is filed, a hearing must be held within five days of filing of the petition. In extraordinary circumstances and with a showing of good cause, a hearing date may be extended by 10 days. The court must grant the petition if, by a preponderance of the evidence, isolation or quarantine is shown to be reasonably necessary to prevent or limit the transmission of a contagious or possibly contagious disease. An order authorizing isolation or quarantine may do so for a period not to exceed 30 days.
Section 44-1-150 makes it a misdemeanor offense (punishable with a maximum fine of $200 or imprisoned for 30 days) for any person with notice to “violate, disobey, or neglect to comply with [any lawful] regulation of the Department of Health and Environmental Control.” Additionally, Section 44-4-530(D) makes it a felony—punishable with a maximum fine of up to $2,000 and 30 days in prison—for a nonauthorized person to enter isolation or quarantine premises.
Under Title 34 Sections 34-1-16 and 34-1-14, the South Dakota Department of Health has the power to make and alter all rules and regulations in the interest of the public health and exercises general supervision over all health officers and local boards of health in the state. Specifically, Section 34-1-17 allows the Department of Health to adopt and enforce rules for the treatment of persons suffering from any communicable disease, the disinfection and quarantine of such persons and places in case of disease, and the reporting of sickness and deaths from disease.
Similarly, Section 34-22-9 mandates that the Department of Health establish and direct the operations of a statewide system for communicable disease prevention, control and treatment. This includes the monitoring, quarantine and isolation of any patient or carrier of a communicable disease. Section 34-22-12 requires the State Department of Health to collect reports of identifiable and suspected cases of communicable disease and communicable disease carriers from all physicians, hospitals, laboratories and institutions. Separately, Section 34-22-14 gives the Department of Health the authority to provide for the enforcement of regulations for the control and eradication of communicable diseases through isolation, prevention and treatment.
Section 34-22-5 makes intentional self-exposure to another person infected with any communicable disease a Class 2 misdemeanor (punishable by no more than 30 days' imprisonment in a county jail or a $500 fine). Similarly, Section 34-22-18 states that “any person who intentionally refuses to accept the diagnosis or treatment, or both, or who fails to follow the reasonable and necessary directives of the department issued for the protection of other persons, is guilty of a Class 1 misdemeanor,” with potential punishments of up to one year's imprisonment and up to $2,000 in fines.
Tennessee Code Section 68-1-201 empowers the health commissioner to declare a quarantine whenever the commissioner judges that “the welfare of the public requires it” and to “[p]rescribe such rules and regulations as may be deemed proper for the prevention of” epidemic diseases into the state. If an epidemic disease appears in the state, the commissioner must prescribe such rules and regulations that will “with the least inconvenience to commerce and travel, prevent the spread of the disease.”
If there is a disease outbreak that poses a danger of an epidemic, the commissioner must make appropriate recommendations to the governor for actions “to allocate all available heath [sic] care resources in the affected areas for immediate and long-term health care needs of the affected populations.”
Tennessee county health officers are also empowered to order quarantine, “if the county health officer finds that quarantine is necessary to protect the public health from an epidemic.” Officers can also close public facilities or buildings if they find “unsanitary conditions of such a nature and extent to significantly threaten the public health.”
Tennessee Rule 1200-14-04-.06 fills in the procedural gaps in the statute. Health officers may petition the General Sessions Court in the county where an individual lives for an order for a public health measure. Public health measures do not explicitly include quarantine, but include virtually identical measures, such as an individual living in a designated place and “commitment to the custody of the Commissioner for placement in an appropriate institutional facility or other supervised living situation.”
The order must be for the purpose of guarding “the public against a disease that poses a health threat to others.” The health department has the “burden of proving that reasonable cause exists, based on sound clinical or epidemiological evidence, to believe that there is a substantial likelihood that the carrier or premises poses a health threat to others by clear and convincing evidence.” The petition must state that grounds and facts demonstrating that the individual “poses a health threat to others, the proposed public health measure is the least restrictive alternative, and the type of relief sought.”
The rule also provides for a hearing regarding the petition, which must not be set before five days have passed from the date the petition was served “without the consent of the affected person.” The rule provides for certain items the notice of the hearing must contain, such as the right of the individual to “appear at the hearing and to subpoena, present and cross-examine witnesses”; “the person’s right to have a personally-selected physician perform an examination and the right to review the results of any examination or test being used to support the petition”; and the right of the individual to counsel or court-appointed counsel if the individual is indigent.
The individual or health department may appeal the court’s decision, and the individual may also file a petition for a writ of habeas corpus. The General Sessions Court’s status determination remains in force while the appeal or habeas petition is pending.
It is a class B misdemeanor to “willfully disregard[] or evade[] quarantine” or violate “any rule or regulation made in attempting to prevent the spread of any epidemic disease.”
The Texas Health & Safety Code provides that the department of state health services must “impose control measures to prevent the spread of disease in the exercise of its power to protect the public health.” Unless the department preempts any local health authorities, such bodies have authority over control measures (which can include quarantine and isolation) in their jurisdiction, but the department may amend, revoke or revise such measures. Texas has different types of municipalities—three types of “general-law” municipalities, which are incorporated under the general laws of Texas; one “home-rule municipality,” which are cities with over 5,000 residents with the power to adopt their own charter for self-government; and one “special-law” municipality. Type A general-law municipalities and home-rule municipalities are empowered to adopt quarantine rules.
If the department of state health or a different health authority has “reasonable cause” to believe that an individual has or has been exposed to a communicable disease, it may order the individual or the individual’s guardian to “implement control measures that are reasonable and necessary to prevent the introduction, transmission, and spread of the disease.” Any order must be in writing and be delivered to the individual. The Texas Code also provides for the imposition of control measures for groups of five or more.
Texas Health & Safety Code Sections 81.151–81.212 provide detailed procedures for court orders for the management of persons with communicable diseases, including procedures for groups. State and local authorities request that either the attorney general or the county/district attorney, respectively, file a sworn written application for court management. Among other items, the application must contain “a statement that the person is infected with or is reasonably suspected of being infected with a communicable disease that presents a threat to public health.”
No later than 24 hours after an application has been filed, the judge must appoint an attorney for the individual if the individual does not have one already. The judge must also set a hearing to be held within 14 days after the date when the application was served; the court may grant one or more continuances, but the hearing must take place no later than 30 days after the application was served. If the individual or the individual’s attorney objects, the hearing may not be held within the first three days.
The individual’s attorney may request information from the attorney general or local attorney who submitted the application. That attorney must then provide a statement “within a reasonable time before the hearing” that includes the statutory basis for the court order; the name and contact information of any witnesses testifying at the hearing; “a brief description of the reasons why temporary or extended management is required”; and “a list of any acts committed by the person that the applicant will attempt to prove at the hearing.”
Pending the hearing, the individual may remain at liberty unless the individual is detained under another provision. In fact, it is also possible for state or local authorities to file a motion for an order of protective custody, but “only in the court in which an application for a court order for the management of a person with a communicable disease is pending.” It must include an affidavit of medical evaluation. The judge must find that the “health authority or department has stated its opinion and the detailed basis for its opinion that the person is infected with or is reasonably suspected of being infected with a communicable disease that presents an immediate threat to the public health”; and that the individual is not in compliance with the written control measure order.
If a protective order is issued, a hearing is required to determine whether there is probable cause to believe that the individual “presents a substantial risk of serious harm to himself or others to the extent that the person cannot be at liberty pending the hearing on a court order for the management of a person with a communicable disease; and the governmental authority “has stated its opinion and the detailed basis for its opinion.” The hearing must be held no later than 72 hours after the individual is detained, though there are some possibilities for extensions.
There is a jury trial right in a hearing for “extended management,” and in a hearing for “temporary management,” the individual or their attorney may also request a jury. There is also a procedure for appeals from orders for management of individuals with communicable diseases, and nothing in the statute limits the right to obtain a writ of habeas corpus.
The code also provides for quarantine measures for an entire area. An area quarantine may only be imposed if the commissioner has “reasonable cause to believe that individuals or property in the area may be infected or contaminated with a communicable disease,” only for the time period “necessary to determine whether an outbreak of communicable disease has occurred.” A local health authority may only impose an area quarantine after consulting with the state-level department. It is a felony in the third degree for an individual to violate or refuse to comply with any rule, order or instruction under the subsection.
Notably, in Texas, a declaration of a public health disaster cannot last longer than 30 days, though the commissioner may renew it one time but only for an additional 30 days. A public health disaster is defined to include the commissioner’s determination that a communicable disease is an immediate threat that poses a high risk of death or substantial risk of public exposure.
Knowingly refusing to comply with a quarantine or isolation measure or interfering with it is a class B misdemeanor. It is also a class B misdemeanor to remove, tamper with, or destroy quarantine devices.
The Virgin Islands Code does not provide a lot of detail regarding quarantine and isolation powers. It gives the Commissioner of health the power to declare any disease a communicable disease. To prevent infection, the commissioner may prescribe procedures that patients, the patients’ householders, physicians or any individual in contact with the patient must follow. These regulations become effective when the governor approves them.
Such regulations may include “quarantine or isolation of the patient, of any persons who have been exposed to the patient and therefore liable to have contracted the disease, or of any carrier of the disease.” They may also include putting up signs on the premises where the infected individual is; “any other matter relating to the care of and due to the illness of the patient from such a communicable disease while the patient is living and ill from the disease, or to the disposal of his body when dead”; removing the patient or facilitating the patient’s return to school; and “any other matter or procedure of interest in the protection of the public.”
The governor’s proclamation of a state of emergency also activates additional powers. However, the definitions of “emergency” and “major disaster,” which activate these powers, focus on natural disasters such as hurricanes and tsunamis. Assuming the governor could declare a state of emergency in response to a pandemic, the governor becomes commander-in-chief of “all forces available for emergency duty.” The governor may delegate, “[t]o the greatest extent practicable,” authority through orders. The governor may order evacuation of all or part of a population and may “[c]ontrol ingress and egress to and from an effected area, the movement of persons within the area and the occupancy of premises, including barges, boats, ships and other watercraft therein.” The governor is also empowered to “[t]ake any other action he deems necessary.”
It is a crime for individuals to willfully expose themselves or others with a contagious or infectious disease in any public place, unless the individual needs to be removed and the manner is the “least dangerous to the public health.” Anyone convicted of this crime is subject to a fine of up to $200, imprisonment for up to one year or both.
The Utah Communicable Disease Control Act gives the state Department of Health the “authority to investigate and control the causes of epidemic infections and communicable disease.” Title 26 Section 6-4 of this law empowers the state Department of Health to issue orders of restriction requiring examination, treatment, quarantine or isolation for the following individuals:
1. an individual who is infected or suspected to be infected with a communicable disease that poses a threat to the public health and who does not take action as required by the department or the local health department to prevent spread of the disease;
2. an individual who is contaminated or suspected to be contaminated with an infectious agent that poses a threat to the public health and that could be spread to others if remedial action is not taken;
3. an individual who is in a condition or suspected condition which, if exposed to others, poses a threat to public health, or is in a condition which if treatment is not completed will pose a threat to public health; and
4. an individual who is contaminated or suspected to be contaminated with a chemical or biological agent that poses a threat to the public health and that could be spread to others if remedial action is not taken.
Section 6b-3(2)(a) under this same title adds that a state Department of Health’s decision to issue an order of restriction to an individual or group must be based on the totality of circumstances. Part (b) of this same section states that this order must also:
1. be for the shortest reasonable period of time necessary to protect the public health.
2. use the least intrusive method of restriction that, in the opinion of the department, is reasonable based on the totality of circumstances known to the health department issuing the order of restriction.
3. be in writing, unless the delay in imposing a written order of restriction would significantly jeopardize the department's ability to limit the transmission of a communicable or possibly communicable disease that poses a threat to public health.
4. contain notice of an individual’s rights.
When a verbal order of restriction is issued, it is valid for only 24 hours, and may be enforced by a first responder until the Department of Health is able to maintain the place of restriction. According to Section 6b-3.3, a written order of restriction must include:
The identity of the individual or a description of the group of individuals subject to the order of restriction;
The identity or location of any premises that may be subject to restriction;
The date and time for which the restriction begins and the expected duration of the restriction;
The suspected communicable disease;
The requirements for termination of the order of restriction, such as necessary laboratory reports, the expiration of an incubation period, or the completion of treatment for the communicable disease;
The medical or scientific information upon which the restriction is based; and
A statement advising of the right to a judicial review of the order of restriction by the district court.
Under Section 6b-3.1, an individual can either consent in writing to an order of restriction or obtain judicial review. If an individual contests an order of restriction, Section 6b-6 requires a hearing be held within 10 business days of the order of restriction being issued. Individuals contesting an order of restriction have the following rights, as listed in Section 6b-3.3(2):
The right to be represented by legal counsel;
The right to participate in any hearing, in a manner established by the court based on precautions necessary to protect the public health;
The right to respond and present evidence and arguments at a hearing; and,
The right to review and a copy of all records in the possession of the department that issued the order of restriction.
To grant an order of restriction, Section 6b-6(6)(a) requires that a court find by clear and convincing evidence that the individual or group of individuals are infected with a communicable disease or infectious agent, that poses a threat to public health; there is no appropriate and less restrictive alternative to a court order of examination, quarantine, isolation and treatment; the petitioner can provide the individual or group of individuals with treatment that is adequate and appropriate; and it is in the public interest to order the individual or group of individuals to submit to involuntary examination, quarantine, isolation and treatment. To determine this last variable Section 6b-6(6)(a)(iv) lays out four factors: the personal or religious beliefs of the individual or group to be quarantined, the ability of the department to control the public health threat with treatment alternatives that are requested by the individual, the economic impact for the department if the individual is permitted to use an alternative to the treatment recommended, and other relevant factors.
If the state Department of Health is seeking to extend or renew an order of restriction, Section 6b-7 requires the department to reexamine any order at least two weeks prior to its expiration and inform the court that issued it that the order was about to expire. If the petitioner determines that the conditions justifying that the court's order no longer exist, the state Department of Health is required to discharge the individual from involuntary quarantine, isolation or treatment and immediately report its action to the court for a termination of the order.
Under Section 6b-3(4), the department that issued the order of restriction is required to take reasonable measures, including the provision of medical care, as may be necessary for the involuntary examination, treatment, isolation or quarantine of an individual ordered to submit to an order of restriction.
Additionally, Section 6b-3.3(4)(a) states that an individual subject to an order of restriction may not be terminated from employment if the reason for termination is based solely on the fact that the individual is or was subject to an order of restriction. Finally, Section 6b-3.1(2)(b)(i) requires the department to immediately lift an order of restriction if the conditions justifying the order of restriction for either a group or an individual no longer exist. Any willful or knowing violation of an order of restriction is a Class A misdemeanor under Section 6-5 and is punishable by up to 364 days in jail and a fine of as much as $2,500.
The State Board of Health is responsible for giving “information relative to the cause and prevention of disease and directions as to modes of management, quarantine, and means of prevention of contagious and infectious diseases.” Title 18 Section 126(d)(5) empowers the State Board of Health to issue health orders. These orders include the ability to quarantine or isolate any area, persons, animals or materials Vermont’s commissioner of health also has the power to quarantine a person diagnosed with or suspected of having a disease dangerous to the public health under Section 1004(a). Additionally, Section 1004 also gives physicians the power to temporarily quarantine individuals they suspect of carrying communicable diseases. After this initial quarantine is made, a health officer will examine the temporarily quarantined individual. Section 2 defines “health officers” as the commissioner of health, the commissioner's designee, or a local or district health officer.
If a patient who has a communicable disease subject to quarantine leaves a hospital or institution without the consent of the authorities, Section 1007 requires that institution to notify those authorities. Separately, Section 6 penalizes any “person who in any way interferes with a member of the State Board of Health, a local health officer, or the director, chemist, or inspectors of the State laboratory, in the performance of their duties” by fining them a maximum of $50 for the first offense and $100 for each subsequent offense.
Under the Code of Virginia, the State Board of Health consists of 15 residents of the commonwealth appointed by the governor for four-year terms. Title 32 Section 42 gives the State Board of Health the ability to promulgate regulations and orders to meet any emergency or to prevent a potential emergency caused by a disease dangerous to public health. Section 39 empowers the board to provide for the surveillance of and investigation into all preventable diseases and epidemics and into the means to prevent such diseases and epidemics. This section allows the Board of Health to do this through contact tracing as well as direct investigation. If the State Board of Health believes the resources of a locality are insufficient to provide for adequate investigation, the Board of Health may assume direct responsibility and exclusive control of an investigation and can issue emergency regulations and orders to accomplish the investigation.
If the Board of Health or the state commissioner of health determines an exceptional circumstance exists and one or more persons in the commonwealth have been exposed to or infected and individuals are refusing to comply voluntarily with the control measures, Section 48.05 allows the state health commissioner to invoke his or her quarantine and isolation powers. These powers cannot be delegated or invoked by any local or municipal health officer. Under Section 43, these powers include the authority to require quarantine, isolate, immunize, decontaminate or treat any individual or group of individuals when it is determined that these measures are necessary to control the spread of any disease of public health importance.
However, Section 48.05(B) requires the health commissioner to:
Provide procedures to assure that any quarantine or isolation is implemented in the least restrictive environment;
Ensure that the essential needs of persons subject to an order of isolation issued pursuant to this article shall be met, including, but not limited to, food, water, and health care, e.g., medications, therapies, testing, and durable medical equipment;
Provide procedures for proper notice of orders of quarantine and orders of isolation;
Provide procedures for the State Health Commissioner to issue an emergency detention order for persons for whom he has probable cause to believe that they may fail or refuse to comply with an order of quarantine or an order of isolation; and
Address any other issue or procedure covered herein that the Board deems to be properly the subject of regulation.
Additionally, Section 44 mandates that any quarantined or isolated individual should be able “to choose his own treatment, whenever practicable and in the best interest of the health and safety of the isolated or quarantined person and the public.” However, this section also states that “any order of quarantine or order of isolation [related to a person suffering from] any communicable disease [that poses a] public health threat ... shall remain in effect until the person or persons subject to such order of quarantine or order of isolation shall no longer constitute a threat to other persons.” Section 48.014 states that any quarantine or isolation order is enforceable by law enforcement agencies, as directed by the state health commissioner. These powers include, but are not limited to, the ability to detain or arrest any person or persons identified as violating any order of quarantine or isolation, or for whom probable cause exists that he or she may fail or refuse to comply with a quarantine or isolation order. However, part B of this section is also clear that “any person or persons so detained shall be held in the least restrictive environment that can provide any required health care or other services for such person.”
Under Section 27, “[a]ny person willfully violating or refusing, failing or neglecting to comply with any regulation or order of the Board or Commissioner or any provision of this title shall be guilty of a Class 1 misdemeanor unless a different penalty is specified.” Part C of this same section specifies that “[w]ithout limiting the remedies which may be obtained, any person violating or failing, neglecting or refusing to obey any injunction, mandamus or other remedy obtained [to enforce any lawful regulation or order of the Board or Commissioner] shall be subject, in the discretion of the court, to a civil penalty not to exceed $25,000 for each violation.”
Washington’s state quarantine regulations require steps to obtain voluntary compliance by potentially infected individuals before local health officials are authorized to take compulsory measures. It also provides greater process for persons quarantined involuntarily to challenge their detention.
Under Washington’s Administrative Code, local health officers include individuals appointed as local health officers by their local health department, the director of public health of a city-county health department or a delegee appointed by the local board of health.
Before ordering an involuntary quarantine, the local health official must (a) make reasonable, documented efforts to obtain voluntary compliance of the individual or make a determination that, in the professional judgment of the health official, seeking such voluntary compliance “would create a risk of serious harm”; (b) have “reason to believe” the individual or group has been exposed or infected by a communicable disease; and (c) have “reason to believe” the individual or group would “pose a serious and imminent risk to the health and safety of others if not detained for purposes of isolation or quarantine.” Having complied with these three requirements, a local health officer may either order immediate involuntary detention or petition the superior court for an ex parte order authorizing involuntary quarantine or isolation.
Under the first option, immediate involuntary detention, the health officer must provide individuals quarantined with a written emergency detention order providing the justification and details of the detention and a notice informing them of their right to petition the superior court for release and their right to appointed counsel. The health official’s emergency order can last no longer than 10 days.
Under the second option, an ex parte order authorizing involuntary quarantine or isolation, the health officer’s petition to the court must also provide the justification and details of the detention and a declaration by the local health official. The hearing will be held on the petition within 72 hours in order to determine “if there is a reasonable basis to find that isolation or quarantine is necessary to prevent a serious and imminent risk to the health and safety of others.” A court order authorizing involuntary quarantine or isolation also cannot exceed 10 days.
Beyond 10 days, a local health official can petition the superior court for an order authorizing continued detention for up to 30 days. At the hearing for this extension order, the court must now make the finding that confinement is necessary to prevent a serious and imminent risk to public health on the basis of a higher burden of proof, “clear, cogent, and convincing evidence,” rather than the earlier reasonable basis standard. After the first extension, the local health official may continue to petition the court for extensions up to 30 days; however, the standard returns to reasonable basis only.
Washington’s state laws also provide detailed regulation of quarantine conditions, most significantly that the quarantine or isolation “must be by the least restrictive means necessary to prevent the spread of a communicable or possibly communicable disease to others and may include, but are not limited to, confinement to private homes or other public or private premises.” This provision also requires the state to provide “adequate food, clothing, shelter, means of communication with those in isolation or quarantine and outside these settings, medication, and competent medical care” and to consider cultural and religious beliefs of the individual. Additionally, the provision protects the right of any person placed in isolation or quarantine to choose to rely exclusively on prayer for treatment.
Local health officers have control over entrance to the quarantined premises. Any orders issued by a local health officer must be enforced by all state law enforcement and state employees in that jurisdiction, and any violation of either an order issued by a local health officer or these provisions of the Washington state code constitutes a misdemeanor.
Finally, any person quarantined or isolated has a right to seek relief from the superior court and a right to counsel. This includes application for an order to show cause why the person should not be released or a hearing for remedies for breach of conditions of quarantine or isolation. However, the courts may not stay or enjoin quarantine or isolation orders.
In a 1918 case, State ex rel. McBride v. Superior Court for King County, the Washington Supreme Court upheld the state’s quarantine power and further held that, in matters of public health, the legislature may make a health officer’s factual determination final and binding on the public and the courts. The court noted that in designing the quarantine regulations, the legislature recognized that “the whole matter of quarantine must rest ultimately in the judgment of medical men” so as to “avoid the danger of partisan opinion.”
In a 2018 case, Reyes v. Yakima Health District, the Washington Supreme Court affirmed a dismissal by summary judgment of a tort claim for outrage, finding that “a medical professional’s threat to quarantine a patient who refuses to comply with a prescribed treatment regimen for tuberculosis when the medical professional has a reasonable basis for doing so will not support a tort claim for outrage—or intentional infliction of emotional distress.”
West Virginia’s state director of health is empowered to quarantine places and to prevent assembly of people in any place if they or any county or municipal health officer determines that the public health and safety so demands. The State Board of Health may adopt rules and regulations to prevent the introduction or spread of communicable or infectious diseases into or within West Virginia. The director can enforce these regulations by detention or arrest if necessary and has the power to enter into any town, city, factory, train, boat or other place in order to inspect the property for sanitary, hygienic conditions and presence of disease.
County boards of health can declare quarantines within their county if they judge it necessary to prevent the introduction or spread of any communicable or infectious disease. Once such a quarantine is established, the board shall inform the state director of health, in writing and as soon as practicable, of the necessity for the measures. If the director finds no necessity exists, then the measures will be lifted. Until then, the county board of health may enforce the quarantine and confine any infected person, or person liable to spread infection, to their own home or to a place provided by the county for that purpose. If necessary, the board will call for sufficient guard for enforcement of the quarantine order. Failure to comply with any such order or direction by the county board of heath is a misdemeanor. The board of health of any city, town or village has the same powers and duties as does the county board of health under these provisions.
The State Department of Health and the local boards of health may prevent any boat, train or vehicle arriving in the state if they have reason to believe that it is infected with any communicable disease or contains a persons or thing infected with contagious matter. They may detain the vessel, train or vehicle for a time sufficient to examine it and if it is found to be infected, then may further detain it for a time sufficient to disinfect it. If the conductor or driver refuses to stop for such time, he or she will be guilty of a misdemeanor.
West Virginia provides more specific procedures and legal processes for quarantine of patients with tuberculosis or sexually transmitted diseases, but not for general communicable or infectious disease quarantine.
Wisconsin’s statutory scheme hinges on whether the governor declares a public health emergency. If the governor does so and designates the Department of Health Services the lead state agency to respond as the public health authority, Wisconsin law permits the department to order individuals to receive vaccinations and isolate or quarantine “any individual who is unable or unwilling ... to receive vaccination.” Another statutory provision restates that the department may isolate an individual or impose “quarantine of contacts, concurrent and terminal disinfection, or modified forms of these procedures as may be necessary and as are determined by the department by rule.”
The statute further provides the procedures a health officer must take upon suspecting or learning of anyone having a communicable disease. The officer must investigate and facilitate any necessary examinations. The officer must immediately “quarantine, isolate, require restrictions or take other communicable disease control measures” after a “diagnostic report of a physician, the notification or confirmatory report of a parent or caretaker of the patient, or a reasonable belief in the existence of a communicable disease.”
The officer must also investigate any “evasion of the laws and rules concerning communicable disease” and is required to broadly “act to protect the public.” The statute, in mandatory language, provides for “quarantine guards” for enforcement—officers “shall employ as many persons as are necessary to execute his or her orders and properly guard any place if quarantine or other restrictions on communicable disease are violated or intent to violate is manifested.”
Additionally, when the officer finds it necessary to quarantine an individual, “the officer shall remove the person, if it can be done without danger to the person’s health,” to a quarantine location.
The Wyoming state Department of Health may “prescribe rules and regulations for the management and control of communicable diseases.” The Department of Health, through the state health officer, is empowered to “investigate and control the causes of epidemic, endemic, communicable, occupational and other diseases and afflictions” that affect public health. It may also “establish, maintain and enforce isolation and quarantine.” The state health officer may “exercise such physical control over property” and over individuals in the state “as the state health officer may find necessary for the protection of the public health.” However, such control is permissible only for the purpose of carrying out the department’s isolation or quarantine authority. The officer may also close theaters, schools and other public places, and “forbid gatherings of people when necessary to protect the public health.”
Wyo. Stat § 35-4-104 provides that if there is an infectious or contagious disease that is a “menace to public health,” or an epidemic of such a disease, the state health officer may go to the location where the disease exists and provide for an investigation to determine the cause of the disease. If a county health officer establishes quarantine measures, the state health officer, “after close personal inspection,” has the power to “modify or abrogate any or all quarantine regulations” that the county health officer established.
Wyo. Stat § 35-4-103 further provides that if the state health officer finds out that there is an infectious or contagious disease “which is a menace to the public health,” in any part of the state, the state health officer must order the county health officer to immediately investigate and report back the results of the investigation. The state health officer will then direct the county health officer to quarantine the infected place “if in his judgment” the situation requires it.
The county health officer will then place any restrictions upon entry and exit into the quarantine location “as in his judgment or in the judgment of the state health officer are necessary to prevent the spread of the disease from the infected locality.” When the county health officer declares a place to be in quarantine, the officer will “control the population” in a way in which “in his judgment best protects the people and at the same time prevents the spread of the disease.” The state health officer will also “establish and maintain a state quarantine” and “enforce practical regulations regarding” travel if it is necessary for the protection of public health.
The department or county health officer “may employ a sufficient number of police officers who shall be under the control of the county health officer, to enforce and carry out any quarantine regulations the department may prescribe.” If a county health officer establishes quarantine, the officer must immediately report it to the state health officer. The county health officer must also “furnish all supplies and other resources necessary for maintaining the quarantine.”
State and local officials generally have a duty to “cooperate to prevent the spread of diseases, and for the protection of life and the promotion of health within the sphere of their respective duties.”
If an individual refuses to consent to medical treatment or vaccination, or if the individual refuses to consent on another’s behalf, and it is “reasonably needed to protect the health of others from a disease carrying the risk of death or disability,” the state health officer may quarantine the individual or the individual for whom the treatment is refused.
An individual who has been quarantined may appeal to the district court at any time to be released. The court may hold a hearing, but notice must be provided to the state health officer at least 72 hours prior to the hearing. If the court finds that quarantine is “not reasonably necessary to protect the public health” after the hearing, it must order the individual to be released. The burden of proof for the need for such measures is on the state health officer. However, in cases where there is “bona fide scientific or medical uncertainty the court shall give deference to the professional judgment of the state health officer unless the person quarantined proves by a preponderance of the evidence that the quarantine is not reasonably necessary to protect the public health.”
Quarantined individuals have the right to communicate using telephone or other electronic means. However, the state health officer can deny the individual’s right to an in-person meeting with anyone who is not subject to the quarantine “in order to protect the public health.” There is an exception for a parent or legal guardian to be quarantined with a minor patient upon request.
If there is a “public health emergency of unknown effect, the state health officer may impose a temporary quarantine until there is sufficient information to determine what actions, if any, are reasonably needed to protect the public health.”
It is a crime for an individual in quarantine to escape or attempt to escape if the county health officer has not dismissed the individual. The individual is subject to a fine up to $500 or imprisonment up to one year. It is also a crime to intentionally spread an infectious or contagious disease, with a maximum fine of $500, jail term of one year, or both. Anyone who is guilty of this crime is also liable in a civil action in damages to anyone who was infected. Damages include “all expenses incurred by reason of such sickness, loss of time and burial expenses.” The action may be maintained by a deceased individual’s representative.
More broadly, it is a misdemeanor for anyone to violate the department’s rules or regulations for the management and control of communicable diseases or to resist or interfere with officers’ duties. The individual may “be punished by the imposition of such penalty as may be provided by law,” or, in the court’s discretion, the individual may be fined up to $100, imprisoned for up to 30 days or both.
Wyo. Stat § 35-4-114 provides for health care provider and responder immunity from liability during a public health emergency.
