If you are a hospital administrator and your emergency room team diagnoses Ebola in a patient, who are you going to call? Who’s in charge?
Given all the uproar of the last two weeks, you may be surprised that the first call goes to the local health department, then the state and, finally, to the federal government. State and local officials have the lead on public health. Until a national emergency is declared, federal agencies play an advisory role, said Arizona State University law professor James Hodge.
“Day to day it is state and local governments in charge of isolation and quarantine … because day to day these are localized cases,” he said.
Hodge specializes in public health law and public health emergencies. He is the head of the western region (including Texas) of the Network for Public Health Law.
Ebola has put legal experts like Hodge in overdrive.
Earlier this month, Connecticut Gov. Dan Malloy declared a pre-emptive “public health emergency” because of Ebola.
“We are taking this action today to ensure that we are prepared, in advance, to deal with any identified cases in which someone has been exposed to the virus or, worst case, infected,” Malloy said.
No declaration
Dallas County stepped up to the brink of such a declaration but held back. Dallas Mayor Mike Rawlings opposed it and urged the county to seek pledges from health workers exposed to Ebola patients not to travel or mix with the general population.
Rawlings said others could suffer if the county went for an emergency declaration, adding, “We want to make sure that our business enterprise continues to go.”
Hodge said this was curious in light of the emergency declaration issued by the county and Rawlings in 2012 over West Nile virus.
“It’s not saying everybody would panic” if an emergency was declared, Hodge said. “But it’s fair to say when the public sees that, there may be an extremely minimal threat of getting it, but should you get Ebola, the consequences are potentially fatal and certainly horrendous. A declaration could be quite damaging.”
When Dr. Tom Frieden, director of the federal Centers for Disease Control and Prevention, held those news conferences last week, Dr. David Lakey was with him or in the background on a video screen. Frieden was the adviser; Lakey was the one with authority over what was happening in Texas.
Gov. Rick Perry has created a task force on infectious disease preparedness and response to sharpen the state’s handling of Ebola.
Texas’ law
Texas has a public health law “as solid as you could ask to see,” Hodge said. “It’s pretty well laid out, and it was followed to the letter of the law with [Thomas Eric] Duncan, the original patient. But it was sloppy in execution, and resulted in several people remaining in a contaminated residence, in deputies walking in without appropriate protective gear, in a homeless person in the ambulance … those things need to be fine-tuned.”
The federal role as adviser can change immediately if Health and Human Services Secretary Sylvia Burwell or President Barack Obama declares a national emergency.
Even without that declaration, though, Hodge said there is a major shift underway because of Obama’s statements that Ebola represents a national security threat. New screening practices are in use at five U.S. airports, and CDC officials are assisting health agencies in West Africa to screen passengers before they board aircraft.
Emergency teams from both the CDC and the military are preparing to respond if there is another Ebola case diagnosed. Any new cases are likely to be moved quickly to one of the four specialized hospital facilities in the country equipped to handle extremely dangerous pathogens like Ebola.
“If the Defense Department and the Department of Homeland Security determine anything is a national security threat, they’ve got the power to respond. They don’t have to ask for state or local approval,” Hodge said. “You don’t need any more implementation powers to go forward than that one.”
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