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Ohio officials work to get a handle on the Ebola crisis
SHERRY KARABIN
Legal News Reporter
Published: October 30, 2014
As fears about Ebola spread across the country, officials in the United States are stepping up practices to contain its spread and provide care for those few who are infected. But Katharine Van Tassel, a law professor at The University of Akron School of Law and director of the Public Health Law & Science Center and Health Law Program, said little is being done to address the legal side of the potential health crisis.
“Our emergency services personnel are very well prepared for an infectious disease crisis,” said Van Tassel. “However, the public health law in the state which grants officials the power to quarantine people was written in 1953 and is now over 65 years old and is unconstitutional as currently written.
“The law needs to be updated to add a fair and transparent process that citizens can easily use to challenge either the fact that they are being quarantined, or the way that they are being treated while they are being quarantined, such as the lack of the provision of adequate food, medical supplies or other items necessary to daily living. ”
Concerns over the virus took center stage in Northeast Ohio in mid-October after the second infected nurse who treated Thomas Eric Duncan flew from Dallas to Cleveland and back being before hospitalized with Ebola.
Amber Joy Vinson had been visiting family in the Akron area between Oct. 8 and 13 and had a fever when she boarded Frontier Airlines Flight 1143 in Cleveland on Oct. 13 to return Dallas.
Nearly 300 passengers and crewmembers were on the flights and Vinson also had contact with a number of people while in Ohio, some of whom are under voluntary quarantine.
Vinson, a graduate of Firestone High School and Kent State University, was transported to Emory University Hospital in Atlanta for treatment. Her blood test has since shown she is free of the virus and has been released from the hospital.
The Ohio Department of Health has activated a 24-hour-a-day call center (1-866-800-1404) to answer questions about Ebola.
An Oct. 23 Ohio Emergency Management Agency press release announced that 100 percent of Ohio hospitals have completed Ebola preparedness and response drills, including training in how to manage a person who is suspected of being Ebola-positive and the proper use of personal protective equipment (PPE).
"Our hospital partners are doing their part to be prepared in case they have to treat a patient with Ebola,” said Ohio Department of Health Director Richard Hodges. “Training in how to manage an Ebola patient and the proper use of personal protective equipment is essential to ensure Ohio hospitals and their frontline staff are confident in their ability to safely care for Ebola patients.”
“I believe that our health department has the ability to contain this disease,” said Virginia (Ginnie) Abell, director of infection control and clinical safety at Summa Akron City and St. Thomas hospitals.
“We have trained everyone in our triage areas on how to screen potential Ebola patients,” said Abell. “There are two key questions that define Ebola, including whether someone has travelled to Africa within 21 days or had contact with an Ebola patient and whether they have a fever. The fever that meets the criteria for Ebola is 100.4 degrees.
“The Summa hospitals continue to have walk-thru drills at intervals and are prepared to evaluate and care for potential and confirmed Ebola cases.”
Under the Ohio Department of Health’s new Ebola quarantine recommendations anyone required to have a public health official monitor their condition daily is prohibited from leaving their health department’s jurisdiction unless the health department jurisdiction to which they are travelling agrees to assume the person’s daily monitoring responsibility.
Those under self-monitoring and reporting requirements can’t leave the country because officials would not be able to track them down in the event they fail to meet their daily reporting requirements.
Whether the ODH policy will face challenges remains to be seen.
On Oct. 4, less than two weeks before concerns about Vinson hit, The University of Akron hosted a joint class/video conferencing session designed to address and explore the legal concerns surrounding an Ebola crisis.
About 50 students took part in “Intersections of Ethics, Law, and Public Health.” Around 35 were physically present at The University of Akron, including students from two combined classes taught by Dr. Julie M. Aultman, associate professor of family and community medicine and director of the Bioethics Certificate Program at Northeast Ohio Medical University (NEOMED).
The two classes included a bioethics class for law students that are part of the Health Law Certificate Program at Akron and a clinical ethics class for bioethics certificate graduate students, who are also medical and pharmacy students from NEOMED. The remaining students came from a third class on public health offered by the Consortium of Eastern Ohio Master of Public Health program directed by Dr. Amy Lee. Consortium public health students who were not present at The University of Akron participated via video conferencing from their respective home institutions of Youngstown State University, Ohio University and Cleveland State University.
“I thought it would be a good idea for law, ethics and public health graduate students to come together to talk about the Ebola issue,” said Aultman, who came up with the idea for the class. “There are a lot of legal and ethical issues surrounding the quarantine and containment of Ebola. We have to respect the autonomy of the patient and the family, while protecting the public from the spread of an infectious disease. This requires a delicate balance.
“From the healthcare perspective, there is the question of whether a provider has a legal obligation to treat someone with Ebola especially if they do not have a way to protect themselves. Ethically we have an obligation to make sure that public officials treat the public humanely.
“If we can implement practices and procedures that are fair, we can help to reduce the stigma or at least the fear of the disease,” Aultman said.
As part of the class, students were posed with a scenario where two people had been identified as having the virus in Northeast Ohio—one person is a single father of two young children, ages 4 and 6; the other is a warden at a prison. Students were asked to explore what the legal, ethical and public health responsibilities were to provide treatment and keep the public safe.
In another scenario, the virus had spread and there were over 200 people showing signs in the Cleveland and Akron-Canton areas. However, there was a shortage of medication and only 50 people would be able to receive the experimental treatments available. In both instances, participants broke out into groups to discuss how the situations should be handled. In scenario number two, they had to figure out if the limited resources should only be used in the United States.
Before each breakout session, there was a panel presentation by Lee and Aultman, along with Van Tassel and Dr. Michelle Renee Chyatte, who is an assistant professor of family and community medicine at NEOMED.
“These hypothetical situations raise concerns that our public health law does not deal with,” said Van Tassel. “For example, when a person is arrested and their liberty is taken because he/she is accused of a crime, there are elaborate processes in place to ensure that the person’s rights are constitutionally protected.
“However, if innocent people who are just in the wrong place at the wrong time are told by the government to quarantine themselves at home for weeks on end, taking away their liberty, there is no process in place to protect their constitutional rights. Importantly, there is nothing in the law that says people are entitled to keep their jobs or be paid. In some cases, not getting paid for three weeks would amount to personal ruin. We are all in this together and those members of our community who are sacrificing their freedom for the good of the community should not suffer financially. A system, like that in place for those who do jury duty, should be adopted.”
Other unanswered questions, said Van Tassel, is how someone would be able to get food if quarantined. “In the case of the single father from the class, what will happen to the children? If you take young children away from a parent they will be distraught. Procedures need to be in place so that the government doesn’t just take possession of the children and cut the parent out.
“We need to think this through and provide a process that makes it clear that a parent retains their constitutionally protected parental rights even when in quarantine and isolation. One example of a way to maintain that bond is to provide the equipment so that a parent can Skype with his or her children so they can stay in touch,” said Van Tassel.
“When the government steps in and begins to take away parental rights without using a fair process, it is likely that parents will challenge the law that we have now, which would not hold up in court at the very time we need it most, during a public health crisis.”
Scott Gedeon, of counsel at Fisher & Phillips, said he’s received numerous calls from employers in a variety of industries like hospitality, healthcare and education, asking how to proceed in the event that one of their workers is exposed to Ebola.
“We are telling employers to remain calm and not to make rash judgments should someone come forward,” said Gedeon. “It is not necessary to determine the individual’s status with the company right now. The only thing that is important is that the person be given medical attention.”
He said the EEOC (Equal Employment Opportunity Commission) and OSHA (Occupational and Safety Health Administration) have not provided any sort of guidance so his firm is advising clients to look to the CDC and “not to make any ‘knee-jerk’ decisions.
“If someone is quarantined, employers should follow the policies and procedures in place for payment of compensation or the use of sick leave. We are encouraging them to be gracious and remember the situation is beyond the employee’s control.”
“At this stage it is highly unlikely that public health authorities will impose any draconian measures in Northeast Ohio,” said Terry O’Sullivan, associate professor of political science at The University of Akron and associate director of the Center for Emergency Management and Homeland Security Policy Research. “Officials are interviewing anyone who may have come into contact with Ms. Vinson, the Dallas nurse, and they will ask a small number of those people to voluntarily quarantine themselves. I would say there is a very low chance that anyone in Akron will turn out to have been infected. However, public health officials will err on the side of caution to make sure no one slips through the cracks.
“While setting up a quarantine in West Africa may sound like a good idea, it would backfire and cause people who are sick to go underground and spread the epidemic further,” O’Sullivan said.
Van Tassel said officials must act now to revise the old law and get procedures in place that are constitutional.
“We want to have a plan in place so that people trust the government and choose to cooperate. If people do not trust the government, they may flee and spread the virus further,” said Van Tassel. “It is imperative that lawyers, healthcare providers and public health officials come together to update Ohio law to properly balance the protection of public health with the constitutional rights of its citizens. ”