Download Fact Sheet on Isolation and Quarantine Legal Authority[1]

Fact Sheet on Isolation and Quarantine Legal Authority1 for the State of California
Introduction
Isolation and quarantine are two common public health strategies designed to protect the public by
preventing exposure to infected or potentially infected persons. Both isolation and quarantine may be
conducted on a voluntary basis or compelled on a mandatory basis through legal authority.
Definitions
According to California Code of Regulations2, isolation and quarantine are defined as follows:
Isolation: “Isolation is defined as separation of infected persons from other persons for the period of
communicability in such places and under such conditions as will prevent the transmission of the
infectious agent.”
Quarantine: “Quarantine is defined as the limitation of freedom of movement of persons or animals that
have been exposed to a communicable disease for a period of time equal to the longest usual incubation
period of the disease, in such manner as to prevent effective contact with those not so exposed.”
State and Local Law
A state’s authority to compel isolation and quarantine within its borders is derived from its inherent
“police power”—the authority of a state government to enact laws and promote regulations to safeguard
the health, safety, and welfare of its citizens. California law expressly authorizes compelled isolation and
quarantine.
Under California Health and Safety Code, the local Health Officer (HO) is granted authority for ordering
and ensuring measures related to isolation and quarantine both before and following a declaration of
emergency. The county Health Officer’s authority includes:
Orders and ordinances of the board of supervisors pertaining to public health and sanitary matters;
Orders including quarantine and other regulations prescribed by the department; and
Statutes related to public health.”3
Health Officer and Declaration of Emergencies
The Health Officer (HO) may proclaim a local emergency if he or she has been specifically designated to
do so by ordinance approved by the county governing body (Board of Supervisors); however, currently in
San Francisco County the health officer is not provided such designation.4 The health officer is, however,
authorized to declare a local health emergency under one condition: “Whenever a release, spill, escape, or
entry of waste occurs…and the director or the local health officer reasonably determines that the waste is
a hazardous waste or medical waste, or that it may become a hazardous waste or medical waste…”5 Such
1
(Reproduced in part from CDC Fact Sheet on Legal Authorities for Isolation and Quarantine, September 2004 and the Santa Clara
County Fact Sheet on Isolation and Quarantine Authority, March 2006.)
17 California Code of Regulations (CCR) 2515, 2520
3
California Health and Safety Code (HSC) § 101300
4
California Government Code § 8630
5
CA HSC § 101080
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declarations of a local health emergency may remain in effect for no more than seven days unless ratified
by the Board of Supervisors.
Health Officer Orders for Isolation and Quarantine
The HO has legal authority to issue individual or mass isolation and quarantine orders to protect the
public health.6 The HO may issue isolation/quarantine orders any time HO has reasonable grounds to
believe the order is necessary to prevent the spread of disease.7 The Isolation/Quarantine order may be
“strict” or “modified”8:
(a) Strict Isolation9: If the disease is one requiring strict isolation, the health officer shall insure that
instructions are given to the patient and members of the household, defining the area within which the
patient is to be isolated and stating the measures to be taken to prevent the spread of disease.
(b) Modified Isolation: If the disease is one in which only a modified isolation is required, the local health
officer shall issue appropriate instructions, prescribing the isolation technique to be followed. The
isolation technique will depend upon the disease.
Obligations of Citizens
Once the health officer issues an order, patients have the duty to obey the orders.10 It is a misdemeanor to
disobey the health officer order.11
Federal Law
The HHS Secretary has statutory responsibility for preventing the introduction, transmission, and spread
of communicable diseases from foreign countries into the United States, e.g., at international ports of
arrival, and from one state or possession into another.12
The communicable diseases for which federal isolation and quarantine are authorized are set forth
through executive order of the President and include cholera, diphtheria, infectious tuberculosis, plague,
smallpox, yellow fever, and viral hemorrhagic fevers. Severe acute respiratory syndrome
(SARS) was added to this list in April 2003.13 Influenza caused by novel or re-emergent influenza viruses
that are causing, or have the potential to cause, a pandemic, was added to the list in April 2005.14
By statute, U.S. Customs and Coast Guard officers are required to aid in the enforcement of quarantine
rules and regulations.15 Violation of federal quarantine rules and regulations constitutes a misdemeanor,
punishable by fine and/or imprisonment. Federal quarantine authority includes the authority to release
persons from quarantine on the condition that they comply with medical monitoring and surveillance.16
6
CA HSC § 120130, 120175
In Re Application of Arata (1921) 52 Cal. App. 380
8
CA HSC § 120130
9
Title 17 CCR § 2516; 2518
10
CA HSC § 120225, 1202130
11
CA HSC § 120275
12
42 U.S. C. §264(a)
13
Executive Order Dated April 4, 2003
14
Executive Order 13375 dated April 1, 2005,
15
42 U.S.C. § 5170b
16
42 U.S.C. § 264
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Interplay between Federal and State/Local Laws
States and local jurisdictions have primary responsibility for isolation and quarantine within their borders.
The federal government has authority under the Commerce Clause of the U.S. to prevent the interstate
spread of disease.
The federal government has primary responsibility for preventing the introduction of communicable
diseases from foreign countries into the United States. By statute, the HHS Secretary may accept state
and local assistance in the enforcement of federal quarantine regulations and may assist state and local
officials in the control of communicable diseases. It is possible for federal, state, and local health
authorities simultaneously to have separate but concurrent legal quarantine power in a particular situation
(e.g., an arriving aircraft at a large city airport). Because isolation and quarantine are “police power”
functions, public health officials at the federal, state, and local levels may occasionally seek the assistance
of their respective law enforcement counterparts to enforce a public health order.
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