Quarantine Powers of Health Officers Katherine M. Anderson

Myobacterium tuberculosis (MTB) now infects one-third of the world's population and is the most common cause of death from infectious diseases globally after a 30-year decline in the United States, the incidence began to rise in 1984. By 1992 the incidence of tuberculosis had increased 20% nationally, and 47% in Washington State.

This revision to the Revised Code of Washington (RCW) 70.28.031 reiterates the broad powers of heaIth officials and states, "While it is important to respect the rights of individuals, the legitimate public interest in protecting the public health and welfare from the spread of a deadly infectious disease outweighs incidental curtailment of individual rights that may occur in implementing effective testing, treatment, and infection control strategies."

To ensure that this authority would not be used to discriminate against classes of people, the law includes this section: "To protect the public's health, it is the intent of the legislature that local health officials provide culturally sensitive and medically appropriate early diagnosis, treatment, education, and followup to prevent tuberculosis. Further, it is imperative that public health officials and their staff have the necessary authority and discretion to take actions as are necessary to protect the health and welfare of the public, subject to the constitutional protection required under the federal and state constitutions."

In the 1980 case of the State v. McQuackey, Seattle District Court judge ruled that the state statute authorizing involuntary quarantine was unconstitutional because it denied the defendant due process. However, the court also stated that the ruling applied in that case only to avoid a possible repeal of that case the Washington Administrative Code (WAC) was revised by the State Board of Health in 1995 to give clear directions on the steps necessary for involuntary detention. The health officer must document the actions used to obtain voluntary compliance by the patient with the normal and necessary procedures in testing for or treating TB.

When a decision to detain has been made, the infected person must be given written notice of what is to occur, the right to legal counsel, and other rights under the law. The health officer must file a petition for detention with the superior court within one judicial day. This document must describe the patient's noncompliance and give the names and addresses of persons who support the detention decision.

The hearing must occur within 72 hours of the detention. After the hearing the court may release the person if the health officer has not attempted less restrictive measures, or may order the person to be detained for up to 45 days. At the end of that period a new hearing must be held, at which time additional detention up to 180 days may be ordered. These procedures may continue until the person complies or adequate therapy has been provided.

In the first year of the new law, 278 cases of active TB have been reported in Washington. Judicial intervention has been required in only three instances - mandated compliance with directly observed therapy twice and electronically monitored home quarantine once. Most cases only require standard, voluntary case management techniques, though the threat of legal action may "inspire" compliance in some cases. Unfortunately, some infected persons "disappear" before action is taken.

One deterrent to local health departments' use of the new law is their financial liability for quarantine. Hospital-based quarantine costs about $1,100 per day. Home quarantine with electronic monitoring costs only $15 to $20 per day, but does not allow control of who visits the infected person.

Recommended Reading

Annas GJ: Control of tuberculosis: The law and the public health. N Engl Med 1993;328:585-588.

Baver R, Dubler NN, Sheldon L: The dual epidemics of tuberculosis and AIDS: Ethical and policy issues in screening and treatment. A. J Public Health 1993;83:649-654.

Nolan CM: A new era of TB resurgence demands updated laws and regulations. Washington Public Health 1994;12:1-3.

Control of Tuberculosis, Chapter 70.28.031 RCW Olympia, WA: Washington State Legislature, 1995.

WAC Tuberculosis: Prevention, Treatment, and Control. Chapter 246-170 WAC. Olympia, WA: Washington State Legislature, 1995.

Author

Katherine M. Anderson, R.N., B.S.N., was coordinator of the Tuberculosis Control Program of the Washington State Department of Health from 1988 through May 1996. 

Return to Northwest Public Health