Involuntary isolation or quarantine can occur in a non-secure home or facility. Persons may comply even without security because the use of the legal process demonstrates the seriousness of the matter. Furthermore, your state's laws may require the use of the least restrictive setting possible. The need for security will depend on the facts of the case. If security is necessary, electronic home detention may be an option. The use of correctional facilities depends on your state's laws, and your attorney should be consulted.
Authority . In some states Local Health Officers(LHOs) are the only officials who may initiate involuntary I/Q, whether in a hospital or in the community. If a LHO decides to initiate involuntary isolation and/or quarantine, s/he must follow the procedures contained in the state laws. This toolkit contains a variety of forms and process flow charts for planning the implementation of involuntary detention in the Tools & Samples section.
Process . We've identified six key elements involved in processing an involuntary detention.
- Activation and Decision. Define protocols for when and how to activate the detention process for a case requiring involuntary isolation/quarantine.
- Choice of Health Officer Order or Court Order. Include in your protocols the alternative mechanisms to initiate detention by Health Officer order or petition to the court for a detention order, if your state's laws allow both.
- Continuing Detention. Depending on your state's laws, involuntary isolation and quarantine orders are time limited. The health officer must petition the court for continued detention beyond the period of initial detention. It is important to track due dates, make decisions, prepare pleadings, and schedule hearings within the required time frames.
- Locations for Detention. Before activating involuntary detention, it is essential that you know where detention will occur. In Washington, a LHO is required to use a form of detention that meets the needs of isolation/quarantine while creating the least amount of impact on an individual's personal freedom. Your state may be similar.
- Conditions of Detention. These conditions include the requirements that Public Health meet the needs of the persons to the greatest extent possible, consider cultural and religious beliefs, and release individuals as soon as it is practical.
- Transportation. Individuals who are subject to involuntary detention for isolation/quarantine may need to be transported to a place of detention and to court hearings. Law enforcement and emergency medical services agencies are likely partners to help with transportation issues.
- Release from Detention. If continued detention is not necessary, consider any additional needs of the individual and any documentation that needs to be completed upon release from detention.
Roles and Responsibilities of Others
- Coordination with Hospitals. Our planning assumption is that a hospital will be the location for isolation only if and when a person needs hospitalization. If a person can be discharged but still needs to be isolated, we intend to facilitate transition to other housing. However, it is possible that a person or group of persons may need to be involuntarily detained at a hospital. In this instance, coordination with the hospital would be needed, including service of notice of detention, the logistics of conducting a judicial hearing, and security arrangements. A local work group of hospital attorneys is working with our attorney on a protocol for delivery of isolation orders to hospitalized persons. In Washington, a Local Health Officer is the only official who can order a person to be involuntarily isolated. The protocol will establish the procedure for a hospital to contact the Local Health Officer if it believes that a hospitalized person needs to be ordered to remain isolated in the hospital. The protocol will include model orders.
- Role of Law Enforcement. Public Health officials may need the assistance of law enforcement agencies to enforce a public health order. Relationship building with law enforcement should begin early in your planning process. Law enforcement agencies may raise issues about limits on their authority to enforce orders that are issued by a health officer. They also may have concerns about the perceived risk of interacting with individuals with a known health risk, and will have questions about the applicability of their standard procedures for legal use of force. Items to include in a protocol include: the types of assistance that Public Health may need, for example stand-by support during delivery of an order; the procedure for Public Health to request law enforcement assistance, and the procedure for law enforcement officers to be protected from disease exposure.
Education for the Legal Community
A number of jurisdictions around the country have prepared "Bench Books" for public health emergencies. A Bench Book is a resource for judges to use if they are asked to hear cases involving actions taken by public health officials. It also can serve as an excellent resource for education of the local legal community. King County’s Bench Book contains detailed information about isolation and quarantine. It also contains information about other laws that could be pertinent during an emergency, for example emergency proclamations. In-depth work on isolation and quarantine is an excellent place to start legal planning, and it can lead to legal planning for other questions that could arise during a public health emergency.