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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 2 1 of 3 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 7 2 of 3 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. 3 of 3