emergency response: public health expectations, private provider fears jeff sconyers children’s...
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Emergency Response:Public Health Expectations,
Private Provider fears
Jeff SconyersChildren’s Hospital & Regional Medical
Center, [email protected]
Goals of Presentation: Understand public health response to
emergencies Identify legal risk issues for health care
providers Encourage humility and cooperation Encourage preparation for an emergency
Public Health Emergencies Pandemic disease outbreak Mass casualty event Area-wide emergency
Public Health Interventions in an Emergency Syndrome surveillance, case contact investigation Treatment/prevention interventions
Vaccination/immunization Treatment
Travel/border controls Isolation and Quarantine Social Distancing Restructuring the Health Care System Cordon Sanitaire
Public Health Interventions: Competing Legal Principles - 1
Surveillance/case contact investigation Detection/deterrence of disease Discrimination, privacy concerns HIPAA permits sharing PHI
Vaccination/treatment Controlling the spread of disease Major burden on American principle of autonomy The perils of Jacobson v. Massachusetts295 JAMA 554 (2/1/2006)
Public Health Interventions: Competing Legal Principles – 2
Travel/border controls Highly effective High costs, liberty and discrimination concerns
Social Distancing Effective in limiting the spread of disease High costs; assembly, association and petition
concerns, possible effect on religion
Public Health Interventions: Competing Legal Principles – 3
Isolation and quarantine Effective in limiting spread of disease Social disruption, high costs, liberty concerns
Health Affairs article: “Attitudes Toward the Use of Quarantine in a Public Health Emergency in Four Countries”, Blendon RJ et al., January 24, 2006
1918 Pandemic Flu – Field Hospital
Tent settlement, influenza patients
Pandemic InfluenzaEmergency Response – U.S. Military
Emergency hospital during influenza epidemic, Camp Funston,
Kansas
Pandemic Influenza
Requirements for Health Care Providers during Emergencies Cooperate with syndrome surveillance and
case investigations Provide instruction to patients and staff Cooperate with isolation/quarantine orders Enforce employer-based restrictions
Limits on hours, services, meetings, etc. Workplace quarantine requirements
Restructure services as directed
Key Legal Questions for Providers - 1
Procedural/Constitutional: What additional procedural requirements may be
necessary to comply with constitutional due process guaranties?
What liabilities might health care providers face for implementing or acquiescing in I/Q orders?
Key Legal Questions for Providers – 2 Restructuring the Healthcare System
If public health sets traige, admission, discharge and treatment standards, must hospitals follow them?
Will providers have immunity for following public health directions?
If decisions lead to injury or death (e.g., unhooking a ventilator), what should providers do?
How can providers assure that public health decisions are valid and well-considered?
Key Legal Questions for Providers – 3 Human resource issues
In the chaos and danger of an emergency, what reasonable expectations should providers have?
How can employers help their employees prepare? Vaccinations, home readiness kits, messaging, etc.
Can workers be reassigned to higher-level duties? What help can be given in an emergency? How can we
keep employees at work? Day/elder care, housing, etc. In the recovery period, how can we avoid losing our
workforce? Recovery assistance, pay continuation Are there applicable union contracts?
Key Legal Questions for Providers -4 Exposed health care workers:
Who pays the lost wages of employees who are placed in I/Q?
Should exposed workers be furloughed or reassigned? When can sick employees be allowed back to work? Is it possible to use workplace quarantine? How do employers maintain a safe workplace?
Key Legal Questions for Providers - 5 Operational Issues
Who is responsible for enforcing isolation and quarantine orders? Is it malpractice not to enforce?
What do Public Health and others expect of security personnel? And in what setting – ER, inpatient bed, outpatient clinic?
If a patient must be detained in isolation due to an infectious condition, who will assure the patient stays?
If a patient is admitted to a hospital, how will isolation and quarantine orders be delivered to the patient?
For hospital patients in I/Q, how will a court hearing be conducted – from the patient’s room? What expectations of the hospital?
Key Legal Questions for Providers - 6 Financial:
During an event, what compensation is available to facilities that are used for I/Q?
What compensation is available post-event for continuing losses experienced by I/Q facilities?
Who pays the lost wages of employees who are placed in I/Q as a result of an exposure?
Who is responsible for health care services provided to persons subject to I/Q and detained in a facility? Will third-party payors pay for care provided to persons in I/Q?
Who pays for patients treated as a result of the emergency? The importance of GOOD RECORDS
Ethical Considerations for Public Health Interventions
Transparency Protection of Vulnerable Populations Fair Treatment Social Justice Least Restrictive AlternativeSource: L.O. Gostin, “Pandemic Influenza: Public Health
Preparedness for the Next Global Emergency”, Journal of Law, Medicine & Ethics (Winter 2004), 565-573.
Conclusions Public health interventions, including isolation
and quarantine, are ancient, honorable and effective
Such interventions can cause major disruption to individuals, groups and institutions
Health care facilities would benefit from resolution of open legal issues and collaboration with public health officials to plan for the worst
The time to answer these questions is before the emergency is upon us
Contact InformationJeff SconyersVice President and General CounselChildren’s Hospital & Regional Medical
Center4800 Sand Point Way NE, M/S T-0111Seattle, WA 98105(206) [email protected]