1. Dangerous People, Irrational Fears: Developing a rational jurisprudence for non-criminal dangerousness Edward P. Richards, JD, MPH Director, Program in Law, Science, and Public Health Louisiana State University Law Center richards@lsu.edu Slides and other info: http://biotech.law.lsu.edu/cphl/Talks.htm http://biotech.law.lsu.edu/cphl/Talks.htm

2. Objectives for Today The legal tools for managing dangerous people What is administrative cost and why does it matter? Is more due process and judicial review the right answer to concerns with overreaching state authority? Is law the solution at all?

3. What is Non-Criminal Dangerousness? No mens rea - guilty mind Various legal tests Would not be found criminally liable for their actions Civil (tort) liability Individuals or their care givers can be found liable for tort damages

4. Why does Criminal vs. Non-Criminal Matter? Criminal dangerousness Constitutional due process protections The state can only act retrospectively to punish, based on crimes committed Non-Criminal dangerousness Cannot be punished Individuals can be prospectively managed under the police powers to prevent harm

5. The Police Powers Powers left to the states in the Constitution Primarily public health and safety Commerce clause regulation While the federal government does not have police powers, the courts have allowed the commerce clause to substitute in most situations

6. Police Power Enforcement Enforced through agencies such as health departments, departments of mental health, and other health and safety agencies Historically, less of a separation between the police and public health/safety Governed by administrative law jurisprudence, not criminal law jurisprudence

7. Criminal v. Administrative Due Process

8. Criminal Due Process - Just like on TV Right to counsel Trial by jury No self-incrimination Only searches based on probable cause with a court granted warrant Law must be specific (void for vagueness) Can only be applied for punishment after a crime is committed

9. Administrative Due Process Expert agency decisionmakers rather than trial by jury Judicial deference to agency action Lower standard of proof Preponderance or clear and convincing Can take action to prevent harm Cannot punish, only limit liberty as necessary to prevent harm

10. Example - Administrative Searches Criminal law search Probable cause to believe that there is specific evidence of a crime in a specific place Must be approved by a judge Administrative law search Until 1967, no warrant at all Post 1967, area warrant Both public health and national security

11. Example - Traditional Tuberculosis Control Jargon: Isolation (sick) - Quarantine (exposed) Suspected carriers can be isolated until they test negative No forced testing or treatment, but it is the key to release Orders by health officer, subject to habeas corpus review by a judge Can be kept in a jail (but not a good idea)

12. Tradition Review of Pubic Heath Detention: Habeas Corpus Part of the US Constitution State (health officer) must show: Legal authority for the detention The facts that support the detention No right to appointed counsel Judge will defer to the state's determination of the facts in administrative detentions Must not be arbitrary or capricious

13. The New Direction Push by civil libertarians for more rights since the 1970s More judicial supervision - shift decisionmaking from the agency to the judge or jury More due process rights, including counsel Many states have adopted dramatic limits on traditional public health powers Claimed to be constitutionally required

14. The Result for TB Appointed counsel Judicial determination of the appropriateness of the isolation order In some place, a jury trial on the issues Least restrictive alternative analysis, often without regard to departmental resources

15. Constitutional Cognitive Dissonance: Rehnquist (Roberts) Denial Pretrial detainees in Rikers Bail Reform Act and Fat Tony Sexually dangerous persons laws and predator laws Antiterrorism laws Same constitutional roots as public health From Guantanamo to NSA to FISA, all are based on the power to prevent Criminal rights like 5th amendment are limited Same language as public health decisions

16. Is More Due Process and Judicial Review Good Policy? Why not just have more review by courts and more due process, including appointed counsel?

17. Administrative Cost Limited budgets and staff Many do not have lawyers Limited ability to tolerate political criticism Texas TB case in the 1980s

18. Do Courts do a Better Job? Remember Korematsu? How about how well the criminal courts do with all their protections, if you are not rich? Look at the terrorism cases Presenting a TB case Is judicial review really only a protection to the extent that it keeps the agency from acting?

19. Does it Matter? Most public health works well enough You usually do not get sick eating in restaurants Drinking water is generally safe Restrictions on TB control mostly work because it is relatively rare Would it scale?

20. Problem Areas Legal overreaching Assumption that the problem can be solved with law Usually driven by fear combined with an unwillingness to face structural problems Over-restrictive laws

21. Legal Overreaching: Pandemic Flu Read the HHS report on Swine Flu Pressure to pass emergency restriction and quarantine laws Some people are even talking about shooting policies Government requirements for surge planning and emergency preparedness plans Is this the right answer?

22. Best Evidence-based Pandemic Planning People need food, medical care, and financial support to stay home We eliminated surge capacity as a health planning goal - we called it excess capacity We do not have a working immunization program for the yearly flu pandemic We cannot even get health care provides to get basic immunizations, including flu shots

23. Why Focus on Emergency Laws? Cheap to pass Do not require addressing expensive infrastructural needs Federal and state agencies can point to the coerced plans to show that we are prepared Hurricane Pam and Katrina Systematically undermines confidence in government regulation because everyone has to lie

24. Over-restrictive Laws: HIV

25. Background on HIV 1,000,000++ infected persons More than 20,000/40,000 new cases a year Significantly more deaths than homicides Devastating minority communities #1 cause of death young minority women Much great risk than dangerous mentally ill persons and other politically high visibility risks Now linked up with prostitution, Internet porn, and organized crime Extra charge for bareback and bug chasers

26. Legal/Political Setup for HIV Epidemic Swine flu scared public health officials, esp. CDC Made it difficult for them to push for unpopular intrusive strategies Bathhouses grew up in the early 1970s Horrendous HBV data in 1976 Bathhouse closings were seen as anti-gay civil rights violations Bathhouses made the HIV epidemic possible

27. Legal Restrictions on HIV Control Special legal limits on testing Special exceptions to communicable disease reporting and investigation laws Many states revised their public health laws to make it much more difficult to restrict disease carriers Federal policy on HIV, which sets the norms for states because of funding restrictions, did not address these restrictions until 2005-6 Public health officials do not have the legal power to act against dangerous persons and institutions

28. Why Pandemic Flu Preparedness and not HIV Control? What is the real risk of a public health threat? Why is preparation for theoretical risks so much more attractive than confronting real risks? What is the role of politics (Wag the Dog)? Did Katrina trigger the pan flu push? Is this an extension of the national security state? Should we push back? Pan flu rationing plans are a good sign