Posted on October 26, 2014
FAQs
Isolation limits the freedom of movement or action of a person or animal who is infected (or is reasonably suspected of being infected) with a communicable disease or condition. G.S. 130A-2(3a). Quarantine limits the freedom of movement or action of a person or animal who has been exposed (or is reasonably suspected of having been exposed) to a communicable disease or condition. Under North Carolina law, quarantine also can be used in two additional circumstances: (1) to limit access by a person or animal to an area or facility that may be contaminated with an infectious agent; or (2) to limit the freedom of movement or action of unimmunized persons in an outbreak. G.S. 130A-2(7a).
An order limiting freedom of movement essentially prohibits an individual from going somewhere. It may confine the person to a particular place, such as his home or a health care facility. Or it may prohibit the person from entering a particular place—for example, it may prevent a person from returning to school or work during the period of communicability. In contrast, an order limiting freedom of action limits specific behaviors, but not the ability to move freely in society. For example, a person who is required to refrain from sexual activity during the course of treatment for gonorrhea has had his or her freedom of action restricted.
Either the state health director or a local health director may order isolation or quarantine. G.S. 130A-145.
When a county creates a consolidated human services agency (CHSA) that includes public health, the CHSA director acquires the powers and duties of a local health director, including the power to order isolation or quarantine. G.S. 153A-77(e); 130A-43(c). The CHSA director may exercise the isolation or quarantine authority directly or delegate it to another appropriate person. Note that if the CHSA director does not have the education and experience that is required to be a local health director, the CHSA director must appoint an individual who does. G.S. 153A-77(e). It is customary to delegate local health director powers and duties to that person.
Yes. A public official granted authority under G.S. Chapter 130A may delegate that authority to “another person authorized by the public official.” G.S. 130A-6. Because isolation and quarantine are exercises of the state’s police power, such a delegation should be made to another public official, not to a private person or entity.
An isolation or quarantine order may be issued orally. An oral order should be followed up with a written order as soon as practicable.
Original question: "May the state health director or a local health director issue a 'standing order' for isolation to a community partner, such as a hospital, to prevent an individual suspected of being infected from leaving against medical advice and creating a risk to the public health?"
There is no authority to issue standing orders and such orders may well be an improper delegation of the public health official’s police power. The better practice would be for the health director to identify in advance other appropriate public officials who may exercise the isolation and quarantine authority when the director is unavailable and ensure that community providers have a means to reach such persons by telephone at any hour of any day. The person may issue an oral order over the telephone if necessary, and follow it with a written order as soon as practicable.
Local health directors may exercise their legal powers and duties only in the single- or multi-county areas that are served by their local health departments. An isolation or quarantine order issued by a local health director is probably not valid outside the local health director’s jurisdiction. However, this does not mean that a person who is subject to an order is relieved of the obligation to comply with the terms of the order—the control measures—when he or she crosses the county line. G.S. 130A-144(f) requires all persons to comply with communicable disease control measures adopted by the Commission for Health Services. This law applies throughout the state. So, if a person is diagnosed with tuberculosis in Orange county and told of the control measures while there, he is still obligated to comply with those control measures when he moves to Chatham county. Furthermore, if he violates control measures while in Chatham county, an Orange county isolation order could be used as evidence that he knew he had tuberculosis and was subject to control measures. Thus, for practical purposes, whether the order is "portable" may not matter much.
