Observations from a Public Health Emergency Professor John D. Blum Loyola University Chicago School of Law Institute for Health Law

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 released 4pm plague actually confirmed by state lab 4:05pm Il Governor declares disaster under state powers, requests Presidential Disaster declaration 4:10pm Chicago Mayor declares disaster, Cook County follows suit 4:20p.m. Governor requests access to SNS

Grim Statistics 5-13 : 76 cases, early morning 5-13: 14 dead, 269 dying by mid morning 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, evening

Key Challenges Along the Way Accessing the Stockpile Breaking Down the Stockpile and Distributing the Drugs Getting Antibiotics to First Responders 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 N.H.,Denver,Co. Dark Winter, Oklahoma biological attack Determined Promise, plague in Vegas Scarlet Cloud, anthrax release

Micro Observations Legal is here !! Just What is the Law Here ? Formalities 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 law 1) Release of confidential information to law enforcement 2) Emergency Medical Staff Privileges 3) Professional Licensure Override 4) Isolation and Quarantine of Non- Compliant 5) Mass Quarantine

Court Petitions State of Illinois and Cook County Seek Emergency Isolation Order Emergency Isolation and Quarantine Order ( 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 Communicate

Lessons/Observations 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