disease. This allows the CDC to use its statutory power to monitor, use surveillance, quarantine, apprehend, and isolate an individual for 72 hours. This can be done without due process of the law. The individual is allowed to obtain an attorney for guidance, but the law is in place to protect the public from the spread of communicable diseases in the United States or abroad (National Archives, Federal Register, 2017). On October 24, 2014, before the enactment of the rules for suspension of due process by the CDC, Kaci Hickox, a nurse with Doctors Without Borders, returned to the United States and was held in quarantine. She had been in West Africa and treated a patient with Ebola. Her temperature was taken upon entry to the United States and was 101 degrees. Her temperature was taken with a forehead thermometer and, when taken with an oral thermometer, it was normal. She was held in New Jersey for 3 days and then released to her home in Maine, where the government tried to further hold her. She fought Maine’s government and was allowed to come and go as she pleased as long as she complied with monitoring for infection. Hickox sued the State of New Jersey for unlawful imprisonment, violation of due process, and violation of privacy rights (NBC News, 2015; State of New Jersey Department of Health, 2018). The settlement in the case resulted in New Jersey enacting new procedures that will not hold a person in quarantine unless medically and epidemiologically necessary to prevent the spread of disease. When a quarantine is in place, it must be the least restrictive means and the person quarantined must be informed of their rights (CBS News, 2017; State of New Jersey, Department of Health, 2018). Self-Assessment Quiz Question #9 In a disaster or terrorist attack: a. The rights of the public supersede those of the individual. b. The standard of medical care remains the same. c. Nurses will be expected to exceed the standards of care. d. There is protection from willful acts of negligence.
end of a disaster. The scope and standards of the response and authority to act are determined by laws. Most disasters happen at a local level. Local officials may ask for help from the state, and the state may ask the federal government to intervene with aid. The state may activate the emergency response system and ask for help from the federal government. The Robert T. Stafford Disaster Relief and Emergency Assistance Act is the statutory authority for most federal disaster response activities (Public Law 93-288 as amended, 42 U.S.C. 5121 et seq., 2016). This act is the statutory authority for response activities of FEMA. In the past, disaster relief was sporadic and piecemeal; more than 100 pieces of legislation were enacted. FEMA’s goal is to prepare, respond, and mitigate domestic natural and manmade disasters. FEMA also will help in the recovery process (FEMA, 2020a; FEMA, 2021a; FEMA, 2021b). There have been very few biological or chemical attacks in the United States. Because of this inactivity, the Global Health Security Agenda takes a dual focus of preparedness for bioterrorism and biological attacks from naturally occurring infectious diseases. The US Department of Defense and Homeland Security focuses more on a bioterrorism attack versus naturally occurring infectious diseases. A complex system that integrates both issues rather than a series of programs and laws would afford the country more protection (USHHS, 2021b). In some cases, international coordination is needed to stop the spread of naturally occurring diseases and those spread by bioterrorism. The World Health Organization established the Global Health Security Agenda (GHSA) in response to this need. More than 50 nations participate in GHSA to strengthen global and nations’ capacity to prevent, detect, and respond to infectious diseases occurring either naturally or through deliberate spread (USHHS, 2021b). In response to the largest outbreak of Ebola virus and Middle East Respiratory Syndrome (MERS) and recurrent outbreaks of measles, the USDHHS, in conjunction with the CDC, promulgated rules in January 2017 to suspend due process of individuals who may be suspected of carrying a communicable
STANDARDS OF CARE IN A DISASTER
that could be used in a disaster. These standards are referred to as “Crisis Standards of Care” (CSC) and the IOM guidelines, and these standards have been adopted by many states (The National Academy of Sciences, Engineering, Medicine, 2018). The standards provide recommendations and a process based on incident-specific circumstances to modify standards of care. A framework for ethical considerations is also outlined in the plan by IOM.
The standards of care in a lawsuit are what a reasonably prudent healthcare provider would or would not do under similar circumstances. These standards change to meet the increased needs of care with a shortage of healthcare personnel and resources to provide that care in a disaster situation. The standards shift their focus from the needs of the individual to the needs of the community. In 2009, the USHHS asked the Institute of Medicine (2009) to develop guidelines for standards of care
IMMUNITY FROM SUIT
One must examine the standards of care during the disaster as this lawsuit and the resulting settlement implies (Palmer, 2017). In the CSC, one can be held liable for legal decision factors, such as failure to prepare, failure to educate staff, and acting with gross or wanton disregard (Neil, 2014; The Network for Public Health Law, 2021). Gross or wanton disregard could include abandonment. Post-emergency care would not qualify for the protections from immunity from suit. It is important to know when a disaster has been declared and deactivated. In most states, the governor's or the attorney general’s offices, local health officials, and divisions of emergency management created by state statutes can deactivate the emergency plans. The Uniform Emergency Volunteer Health Practitioners Act (UEVHPA) protects all volunteer healthcare providers from suit. Individual states have the option of adopting this act. This protection is afforded if the healthcare worker does not commit wanton disregard, gross negligence, or criminal acts. The adoption of UEVHPA is important because many healthcare providers come from other states without licenses to practice in the state they are volunteering in. The act allows for quick deployment of medical practitioners to areas of disaster
The Public Readiness Emergency Preparedness Act (PREP) gives the healthcare provider immunity from suit if the provider does not act with willful or wanton disregard (U.S. Department of Health and Human Services, 42 U.S.C.A. § 247d-6d, 2021b). All nurses must check their state’s statutes to see if this act has been adopted to afford this protection to healthcare providers. Following Hurricane Katrina, a class action lawsuit settled for $25 million, calling into question the immunity that is afforded under PREP. The lawsuit alleges that Memorial Medical Center in Louisiana failed to adequately prepare for disasters, specifically Hurricane Katrina. The suit did not allege that the healthcare providers were negligent but that the facility was liable for failure to plan for a disaster adequately. The allegation was that the facility was improperly designed, constructed, and maintained because it lacked emergency power to maintain life-support systems. The systems were in the basement and became inoperable during the disaster, resulting in patient deaths (Cushman, 2011).
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