Protocol for the Isolation and Quarantine of Communicable Disease

State: NY Type: Model Practice Year: 2005

With the CDC predicting a possibility of avian flu pandemic, the Interpol warning about bioterrorism threats, and the existence of emerging infectious diseases such as SARS, the Rockland County Department of Health recognizes the need for measures to address the isolation and quarantine of communicable diseases. Its mandate of protecting the health and safety of the roughly 300,000 Rockland residents has prompted the Department of finding innovations in designing a medicolegal framework on isolation and quarantine with due regard to a Rockland resident's right to due process. The Health Department enlisted the assistance of a widely diverse group of stakeholders. Thus, the Protocol for the Isolation and Quarantine of Communicable Diseases was developed. The Protocol consists of collaborative procedures on isolation and quarantine involving the Judiciary, local law enforcement, and health agencies. The Protocol generated an unprecedented level of support and cooperation from stakeholder agencies previously unaware of their signifcance and contribution to the efort in confronting emerging threats to public health and safety.  
In today's uncertain times, the threat to public health posed by emerging infectious diseases and bioterrorism underscores the need for a comprehensive approach to confront such threat. The Protocol for the Isolation and Quarantine of Communicable Diseases of the Rockland County Department of Health addresses the importance of a collaborative efort of the local health department, local hospitals, law enforcement and the court system to mitigate or minimize havoc that an emerging infectious disease outbreak or an epidemic might have on public health. After the anthrax attack of 2001, the emergence of the avian flu in Southeast Asia, and the SARS epidemic, the need for a comprehensive operational plan to address these pressing issues cannot be understated. The Protocol sets forth guidelines, policies and procedures that will address these threats. This Protocol differs from other approaches since it incorporates and acknowledges the importance of stakeholders that previously only provide passive or supporting roles in addressing the pressing public health threat of an epidemic or an emerging infectious disease outbreak. The Protocol outlined the significantly active roles of law enforcement, the court system, the local health department and other community stakeholders (e.g. Legal Aid Society, etc.).
Agency Community RolesAs in any disease outbreak or epidemic, the Rockland County Department of Health assumes a very significant role addressing the medical aspect, but collaborates with law enforcement, hospitals, and the court system in the implementation of the isolation and quarantine procedures stated in the Protocol. In the event of the need for involuntary isolation and quarantine, the roles of the court system, law enforcement to accord each individual the right to due process are highly valued in our society. The different stakeholders that are involved in the process specifcally address the different needs of the individual under isolation and quarantine proceedings. The Assistant County Attorney assigned to the Health Department and the Health Department's Director of Emergency Preparedness/Public Health conducted a series of meetings with stakeholders (the County Department of Hospitals, the Office of Court Administration of the Rockland Supreme Court, the Office of the District Attorney, the Rockland County Sheriff Department, the Legal Aid Society of Rockland County, and Good Samaritan Hospital). It also utilized the resources of the Rockland County Emergency Preparedness and Bioterrorism Committee (please see NACCHO Model Practice Database, New York -Promising Practice). A good working relationship between the stakeholders was clearly established when the Protocol was finalized and submitted for review and approval by the New York State department of Health. It was the frst of only four protocols out of 57 counties that submitted to be approved and uploaded to the NYSDOH website as a model protocol. Costs and ExpendituresDuring its development, the Protocol required minimal time and cost spent in meetings in its conceptualization, development, and approval. The funding source that supports this practice is the Public Health Preparedness Grant from the CDC being administered by New York State Department of Health. In the event of its implementation in a public health emergency, the actual costs cannot be readily assessed.  Implementation The main objective of the Protocol for the isolation and quarantine is to provide a medicolegal framework for the protection of public health and safety in the face of emerging threats of infectious diseases and bioterrorism agents with due regard to a citizen's right to due process. The outline is as follows: Purpose  Legal Authority  Definition of Terms  Considerations for Implementing Isolation and Quarantine  Initial Steps to Implement Isolation and Quarantine Procedures to Obtain and Implement a Health Order or a Court Order for Isolation and Quarantine  Standards for the Issuance of Health Commissioner's Order for Isolation and Quarantine  Methods of Service of Health Commissioner's Order of Isolation and Quarantine  Judicial Proceedings  Law Enforcement Considerations Court Facilities and Justice Systems  Procedures for Criminal Prosecution  During an actual event, the steps in the outline will be carried out in a deliberate and prompt manner ensuring that due process of the individual/s involved is respected while meeting the need of protecting public health.
The critique sessions of the full-scale exercise evaluating the Protocol provided a collegial and friendly assessment among the stakeholders/participants. A video footage of the exercise provided an audiovisual guide and was later converted to a training video. The evaluation of the smallpox exercise was compared to previous cases of isolation involving tuberculosis. Previous judicial proceedings were conducted enforcing involuntary isolation of TB patients in the county. The comments were tabulated into strengths and weaknesses. The strengths enumerated include the smooth low of communications between stakeholders and the effcient conduct of the judicial proceeding. Law enforcement and court personnel expressed concerns regarding the use of personal protective equipment, getting vaccination prophylaxis prior to contact with infected person and workman's compensation in case health problems appear years later (including adverse reactions to vaccine prophylaxis). The fear of some stakeholders that they may become unwitting vectors in transmitting of the disease to their family was duly noted and readily addressed by the provision that they will have immediate access to vaccine prophylaxis.
There is sufficient stakeholder commitment to perpetuate the practice as demonstrated and ensured by their enthusiastic participation in a full-scale exercise conducted on October 13, 2004. The major players in stakeholder agencies (e.g. Chief Judge of the Rockland Supreme Court, Chief Clerk of the Office of Court Administration of the Rockland Supreme Court, UnderSherif of the Rockland Sherif Department, the Health Commissioner, the Commissioner of the Department of Hospitals, the Director of the Legal Aid Society of Rockland County, the Infection Control Coordinator and the Emergency Department Nurse Manager of Good Samaritan Hospital in Sufern, NY, the Rockland County Law Department, and the Rockland County Executive Office as well as the Rockland County Emergency Preparedness and Bioterrorism Committee) have expressed full support and cooperation.