Mary KennedyDeputy General Counsel

Tennessee Department of HealthSeptember 17, 2014

It is the mission of the Tennessee Department of Health to protect, promote and improve the health and prosperity of people in

Tennessee

What is Public Health?“Public Health is what we, as a society, do

collectively to assure the conditions in which people can be healthy.” Institute of Medicine, The Future of Public Health, 1988

Concerned with the health of the population rather than the individual.

Requires the Department to be concerned with the actions or conditions of an individual, entity or premises which may create a threat to others.

Tuberculosis

E-Coli linked to Raw Milk

Injectable Drug Diversion

Ebola

Authority of the Health DepartmentTenn. Code Ann. Title 68

Chapter 1 – General ProvisionsTenn. Code Ann. § 68-1-102 Commissioner, Chief

Medical OfficerTenn. Code Ann. § 68-1-103 Rules and

RegulationsTenn. Code Ann. § 68-1-104 Duties of

CommissionerTenn. Code Ann. § 68-1-201 Power to

Quarantine

Quarantine and IsolationTenn. Code Ann. Title 68, Chapter 1

Part 2Tenn. Code Ann. § 68-1-201 Power to Quarantine

Tenn. Code Ann. § 68-1-202 Quarantine Stations

Tenn. Code Ann. § 68-1-203 Violation a misdemeanor

What’s the Distinction? Rule 1200-14-1-.01Isolation – Separates an infected or

suspect individual, or from the community during infectious period;

Quarantine – Limits freedom of movement or prevents access to the premises until diagnosis is established or confirmed in order to determine cause and prevent spread of infection

Local Health ServicesTenn.Code Ann. § 68-2-601 et seq.Tenn. Code Ann. § 68-2-603

Establishes County Health DepartmentCreates position of County health directorCreates position of County health officer

Tenn Code Ann. § 68-2-609Establishes authority of County health

officer to issue administrative orders and seek judicial remedies

Disease-Specific ChaptersTuberculosis

Tenn. Code Ann. Title 68 Chapter 9

Sexually Transmitted diseases Tenn. Code Ann. Title 68 Chapter 10

DISEASE CONTROL/HEALTH THREAT PROCEDURES: Rule 1200-14-4.01 et seq.

Identification of the threat;Directive requiring cooperation with

efforts to prevent disease transmission;

Petition for Temporary Hold;Petition for Health Measure;Issuance of Health Measure;

Identification of the ThreatRule 1200-14-4-.03 Reporting a Health Threat to

OthersAny licensed health professional is required to

report a person who may be a health threat to others and is acting in a manner which puts others at risk;

If a carrier who poses a threat flees the state to avoid treatment, isolation or quarantine, TDH may contact health authorities where the carrier is believed to be.

See also Rule 1200-14-1-.02 for reporting of specific diseases to the Health Department

Issuance of the Health DirectiveRule 1200-14-4-.04 Health Directive

Commissioner or Health Officer may issue directive;Based on clinical and epidemiological findings;Written statement, or oral statement followed in writing;Includes findings and specific requirements to diminish

the threat, using least restrictive alternative;If subject refuses testing, presumption shifts to subject;Subject may request review of Chief Medical Officer;Non-Compliance is grounds for seeking health measure.

Temporary Hold in EmergenciesRule 1200-14-4-.05

Health Officer or Commissioner may petition General Sessions Court where person may be found or premises is located for a temporary hold;

Petition is filed under seal;Petition must include supporting affidavit;Petition may be heard ex parte;May order examination, isolation, treatment or, in

case of premises, prevention or restriction of access;

Hold may not exceed 5 business days except by agreement, with outside limit of 15 business days;

Public Health MeasureRule 1200-14-4-.06 Petition for Public Health

MeasureCommissioner or Health Officer may file petition,

under seal, in General Sessions;Must set forth grounds demonstrating threat to

others;Must propose least restrictive measure(s);Evidentiary standard is clear and convincing;Must give 5 business days notice and advise

respondent of rights at hearing;Respondent may appeal or seek habeas corpus, but

order shall remain in force pending conclusion.

Commitment to Custody of the CommissionerRule 1200-14-4-.07

Must be reviewed by Chief Medical Officer at least every 92 days to determine if still appropriate;

Physical commitment must expire after 6 months unless supplemental petition is filed;

May be renewed as many times as necessary if clear and evidence that the threat to the public health continues.

Patient Bill of RightsRule 1200-14-4-.08

Communication with friends, family and counsel;

Treatment shall not be forced, however refusal may compel continued action to protect the public health;

Isolation only when medically necessary;Patient may enter into contracts, vote, execute

instruments, etc.,Patient shall be given maximum freedom

possible;

Patient Bill of Rights (Cont’d)Rule 1200-14-4-.08 (Cont’d)

No mechanical restraints unless medically indicated and prescribed by physician;

All records, reports, legal documents confidential;

Health directives and public health measures should be written in plain language and include Reasons for the action; Tests or treatments expected; Anticipated duration; and Appeal Rights.