Observations from a Public Health Emergency: TOPOFF II

Observations from a Public
Health Emergency
Professor John D. Blum
Loyola University Chicago
School of Law
Institute for Health Law
[email protected]
May 10,2003
Biological agent released at
O’Hare Airport
United Center at NHL Playoff Game
(a more impossible dream than the
Cubs if that can be imagined)
May 12, 2003
Explosion in Seattle
Homeland Security Places Country
on Red Alert
May 12 in the wee hours
NE Illinois hospitals experience
patients in their EDs, with severe
lower respiratory tract infections
Reports from 33 hospitals
Terrible Tuesday May 13
IDPH starts to enter crisis mode
CDC notified, send epidemiologists
Statewide hospital EDs notified of
potential surge
9am case definition developed
11am FBI reports nuclear plant threat
Tuesday Afternoon
• 1 pm, IDPH plague definition
4pm plague actually confirmed by
state lab
4:05pm Il Governor declares
disaster under state powers,
requests Presidential Disaster
4:10pm Chicago Mayor declares
disaster, Cook County follows
4:20p.m. Governor requests access
to SNS
Grim Statistics
5-13 : 76 cases, early morning
5-13: 14 dead, 269 dying by mid
5-13: 57 dead, 403 dying ,evening
5-14: 351 dead,2,214 dying, morning
5-14: 646 dead,2332 dying,evening
5-15: 2,287 dead,4,4433 dying,
Key Challenges Along the Way
Accessing the Stockpile
Breaking Down the Stockpile and
Distributing the Drugs
Getting Antibiotics to First
Mobilizing National Guard,Fire
Departments, Police
Departments,Schools as Distribution
Sites, even IDOT involved in
Breaking Down Pharmaceuticals
Other Key Events
Secretary Ridge advises a “snow day”
Presidential Disaster Declaration
under the Stafford Act
Sec. Thompson issues a Public Health
Emergency under the authority of the
Public health Service Act
Other Elements
A plane crash at Midway
A large building collapses
A few random fights over antibiotics
at distribution centers
A lot of confusion on protective
measures that first responders needed
to take
The Good News !
Only an Exercise
Topoff 2 in Seattle and Chicago
$16 million
8500 hundred people
Actors as patients
TV network created
Multiple agencies
MSEL and PROFLOW, with zingers
Other Bioterrorism Exercises
Topoff 1, May 2000, Portsmouth
Dark Winter , Oklahoma biological
Determined Promise, plague in Vegas
Scarlet Cloud, anthrax release
Micro Observations
Legal is here !!
Just What is the Law Here ?
What executive orders are needed ?
What court orders are needed ?
More Micro
Big Practical Issues
Is it an emergency yet ?
Track the Money
What’s the deal with the Stockpile ?
Still More Micro
Federal Law Questions
What About EMTALA ?
What About HIPAA ?
Can FEMA Do That ?
Legal Preparations
5 Executive Orders- suspend Illinois
1) Release of confidential
information to law enforcement
2) Emergency Medical Staff
3) Professional Licensure Override
4) Isolation and Quarantine of NonCompliant
5) Mass Quarantine
Court Petitions
State of Illinois and Cook County
Emergency Isolation Order
Emergency Isolation and Quarantine
( in lieu of executive orders)
CDC Guidelines for Lawyers
Varying Degrees of Authority for
Isolation and Quarantine
Know Legislative/legal Requirements
Plan Due Process
Drafts in Advance
Contact other Jurisdictions
Engage Courts
Anticipate problems
1) Disease Spreads Quickly
2) We Need Certainty, But We Will
Never Have Certainty (ie. Antrax
vaccine controversy)
3) Chaos Happens
4) Decisive Leadership is
Critical,But At the Wrong Levels
It Maybe Bad
5) Law Is Critical and Confusing
More Lessons
6) Law must be Harmonized (I.e.
quarantine and isolation policies
at 4 levels)
7) Federalism on Steroids
8) “ Everybody says They are in
favor of coordination but nobody
is in favor of being coordinated”
Still More Lessons
9) There are cultural clashes at work
here !
Finally The Law
10) Law is a tool that must be
reexamined continually and must
facilitate , not hinder our
responses capabilities. The
tensions between individual rights
and community need must be
addressed, but in a crisis the law
must promote coordination of
responses in a timely manner