SPONSOR: |
Rep. Maier & Sen. Blevins |
|
& Rep. Spence; Reps. Buckworth, Ewing, Hudson, Ulbrich, Valihura, Keeley; Sens. Adams, McDowell, Henry, Marshall, McBride, Sokola, Vaughn, Amick, Sorenson, Cloutier, Connor, Simpson, Still, Winslow |
HOUSE OF REPRESENTATIVES 141st GENERAL ASSEMBLY |
HOUSE SUBSTITUTE NO. 1 FOR HOUSE BILL NO. 377 |
AN ACT TO AMEND TITLES 16 AND 20 OF THE DELAWARE CODE RELATING TO EMERGENCIES AND PUBLIC HEALTH. |
WHEREAS, the national Centers
for Disease Control has recommended that all states review their statutory
schemes to ensure that those schemes provide specific procedures and authority
in the event of a bioterrorism attack or other emergency involving communicable
disease; and
WHEREAS, Delaware statute
provides the government with broad authority in the event of a declared
emergency, but does not provide sufficient specific procedures and authority
for the government to use in the event of a bioterrorism attack or other
emergency involving communicable disease; and
WHEREAS, model legislation
has been proposed by legal and medical authorities to ensure that state
governments are able to properly react to bioterrorism attacks; and
WHEREAS, the following
legislation is based in part upon that model legislation, with alterations made
to reflect existing Delaware law and situations unique to Delaware; and
WHEREAS, this legislation seeks to specify, not expand, emergency authority and procedures.
Section 1. This Act may be
cited as the "Delaware Emergency Health Powers Act".
Section 2. Add new
subparagraph (8) to Title 16, Section 122 of the Delaware Code, which shall
read as follows:
“(8) The powers and duties of the Department are
subject to the powers and duties granted other entities in Title 20 of the
Delaware Code. Provisions of Title 20
of the Delaware Code which conflict with provisions of this Section shall take
precedence over this Section.”.
Section 3. Delete Title 16,
Section 129 of the Delaware Code, and replace it with the following:
“§ 129. Threatened epidemics;
appointment of officers to enforce regulations and orders.
With the exception of
circumstances encompassed by Title 20 of the Delaware Code, when any contagious
or infectious disease shall become or threaten to become epidemic, and the
local authorities shall neglect or refuse to enforce efficient measures for its
prevention, the Secretary or the Secretary’s designee may appoint a medical or
sanitary officer and such assistants as the Department or Division may require,
and authorize such medical or sanitary officer to enforce such orders or
regulations as the Secretary deems necessary.
Provisions of Title 20 of the Delaware Code which conflict with provisions
of this Section shall take precedence over this Section.”.
Section 4. Add new
subparagraphs (d) and (e) to Title 20, Section 3115 of the Delaware Code, which
shall read as follows:
“(d) If the Governor should determine that a
public health emergency exists, as that term is defined at Section 3132 of this
Title, the Governor shall so indicate in the issuance of a proclamation of a
State of Emergency pursuant to this Section.
(e) The Governor’s
decision to proclaim a State of Emergency and/or a public health emergency
pursuant to this Section is not subject to judicial injunction.”.
Section 5. Delete Title 16,
Section 130 of the Delaware Code, and replace it with the following:
“§130. Reporting of Potential or Existing Public Health Emergencies.
(a)
Except
as otherwise indicated in this Chapter or Chapter 20 of the Delaware Code, the
Secretary of Health and Social Services or his/her designee shall be
responsible for implementing all measures designed to address potential
contagious diseases or infectious diseases in this State.
(b)
A
health care provider shall report all cases of persons who harbor any illness
or health condition that may be potential causes of a public health
emergency. Reportable illnesses and
health conditions include, but are not limited to, the diseases caused by the
biological agents listed in 42 C.F.R. § 72.3 and symptoms of those
diseases, and any illnesses or health conditions identified by the Division of
Public Health as notifiable diseases.
(c)
In
addition to the foregoing requirements, a pharmacist shall report any unusual
or increased prescription rates, unusual types of prescriptions, or unusual
trends in pharmacy visits that may be potential causes of a public health
emergency. Prescription‑related
events that require a report include, but are not limited to:
(1) an unusual increase in the number of prescriptions to treat
fever, respiratory, or gastrointestinal complaints;
(2)
an
unusual increase in the number of prescriptions for antibiotics; and
(3)
any
prescription that treats a disease that is relatively uncommon or may be associated
with bioterrorism.
(d)
Reports
pursuant to paragraphs (b) and (c) of this section shall be made electronically
or in writing within twenty‑four hours to the Division of Public Health,
or within such time less than twenty-four hours as may be established by the
Division of Public Health by regulation.
The report shall include as much of the following information as is
available: the patient’s name, date of birth, sex, and current address
(including city and county); the name and address of the health care provider
or medical examiner and of the reporting individual, if different; and any
other information needed to locate the patient for follow‑up. For cases related to animal or insect bites,
the suspected locating information of the biting animal or insect, and the name
and address of any known owner, shall be reported.
(e)
Every
veterinarian, livestock owner, veterinary diagnostic laboratory director, or
other person having the care of animals shall report animals having or
suspected of having any disease that may be potential causes of a public health
emergency. The report shall be made within twenty‑four hours to the
Department of Agriculture and shall include as much of the following
information as is available: the suspected locating information of the animal,
the name and address of any known owner, and the name and address of the
reporting individual. The Department of
Agriculture shall promulgate regulations implementing this subsection. The Department of Agriculture shall provide
written or electronic notice to the Division of Public Health of any reports
received pursuant to this subsection within twenty-four hours of receipt of
said report, and such notice shall contain all information provided in the
report.
(f)
For
the purposes of this Section, the definition of ‘health care provider’ shall
include out‑of‑state medical laboratories, provided that such
laboratories have agreed to the reporting requirements of this State. Results must be reported by the laboratory
that performs the test, but an in‑state laboratory that sends specimens
to an out‑of‑state laboratory is also responsible for reporting
results.
(g)
Definitions
from Title 20, Section 3132 shall apply to this Section.”.
Section 6. Delete Title 16,
Section 503 of the Delaware Code, and replace it with the following:
“§ 503. Unreported
contagious disease.
When complaint is made or
there is a reasonable belief of the existence of an infectious or contagious
disease which has not been reported as required by § 502 of this Title, the
Secretary of Health and Social Services or his or her designee shall inspect or
cause the relevant building or facility to be inspected and, on discovering
that such disease exists, shall immediately make a report as described in
Section 130 of this Title.”.
Section 7. Delete Title 16,
Section 504 of the Delaware Code, and replace it with the following:
“ § 504. Notifiable
Diseases.
The Division of Public Health
may by regulation declare any disease to be a notifiable disease, as that term
is used in Section 130(a) of this Title.”.
Section 8. Add a new
subsection to Title 16, Section 505 of the Delaware Code, to read as follows:
“(e) The powers and duties of the Division under this Section are subject
to the powers and duties granted other entities in Title 20 of the Delaware
Code. Provisions of Title 20 of the
Delaware Code which conflict with provisions of this Section shall take
precedence over this Section.”.
Section 9. Delete Title 16,
Section 506 of the Delaware Code, and replace it with the following:
“§ 506. Due Process Rights of Quarantined
Individuals.
The Division of Public Health
shall afford persons who are quarantined pursuant to Section 505 of this Title
the same due process rights as those afforded to persons who are quarantined
pursuant to 20 Del. C. § 3138.”.
Section 10. Delete Title 16,
Section 508 of the Delaware Code, and replace it with the following:
“§ 508. Tracking of Potential
or Existing Public Health Emergencies.
The Division of Public Health
shall ascertain the existence of cases of an illness or health condition which
may be potential causes of a public health emergency; shall investigate all
such cases for sources of infection and to ensure that they are subject to
proper control measures; and shall define the distribution of the illness or
health condition. To fulfill these
duties, the Division of Public Health shall identify exposed individuals as
follows:
(a) Acting on information developed in accordance with Section 130 of
this Title, or other reliable information, the Division shall identify all
individuals thought to have been exposed to an illness or health condition
which may be potential causes of a public health emergency.
(b) The Division shall counsel and interview such
individuals as appropriate to assist in the positive identification of exposed
individuals and develop information relating to the source and spread of the
illness or health condition. Such
information includes the name and address (including city and county) of any
person from whom the illness or health condition may have been contracted and
to whom the illness or health condition may have spread.
(c) The Division shall close, evacuate, or
decontaminate any facility or decontaminate or destroy any material when the
Division reasonably suspects that such facility or material may endanger the
public health.
(d)
An
order of the Division given to effectuate the purposes of this Section shall be
enforceable immediately.
(e)
Whenever
any agency of the State learns of a case of a reportable illness or health
condition, an unusual cluster, or a suspicious event, it shall immediately
notify the Division.
(f)
Whenever
the Division learns of a case of a reportable illness or health condition, an
unusual cluster, or a suspicious event that it reasonably believes has the
potential to be caused by bioterrorism, it must immediately notify the public
safety authority and federal health and public safety authorities.
(g)
To
the extent practicable consistent with the protection of public health, prior
to the destruction of any material under subsection (c), the Division shall
institute appropriate civil proceedings against the material to be destroyed in
accordance with the existing laws and rules of the Superior Court or any such
rules that may be developed by the Superior Court. Additionally, persons whose property is destroyed pursuant to
subsection (c) shall be entitled to seek compensation pursuant to and subject
to the restrictions and procedures described in Title 20, Section 3148.
(h)
Definitions
from Title 20, Section 3132 shall apply to this Section.”.
Section 11. Add a new Section
532 to Title 16 of the Delaware Code, to read as follows:
“§ 532. Health Emergencies.
The provisions of this
subchapter are subject to the provisions of Title 20 of the Delaware Code. Provisions of Title 20 of the Delaware Code
which conflict with provisions of this subchapter shall take precedence over
this subchapter.”.
Section 12. Add a new
Subchapter 3 to Title 16, Chapter 12 of the Delaware Code, to read as follows:
“Subchapter
III: Confidentiality of Personal Health Information.
§ 1230. Definitions.
As used in this Subchapter,
the following terms shall have the following meanings:
(1)
‘Expunge’ or ‘expunged’ means to permanently
destroy, delete, or make non-identifiable.
(2)
‘Informed
consent’ means a written authorization for the disclosure of protected health
information on a form substantially similar to one promulgated by the
Department of Health and Social Services which is signed in writing or
electronically by the individual who is the subject of the information. This authorization shall be dated and shall
specify to whom the disclosure is authorized, the general purpose for such
disclosure, and the time period in which the authorization for the disclosure
is effective.
(3)
‘Legitimate
public health purpose’ means a population-based activity or individual effort
primarily aimed at the prevention of injury, disease, or premature mortality,
or the promotion of health in the community, including:
(a)
assessing
the health needs of the community through public health surveillance and
epidemiological research;
(b)
developing
public health policy; and
(c)
responding
to public health needs and emergencies.
(4)
‘Protected
health information’ means any information, whether oral, written, electronic,
visual, pictorial, physical, or any other form, that relates to an individual’s
past, present, or future physical or mental health status, condition,
treatment, service, products purchased, or provision of care, and that reveals
the identity of the individual whose health care is the subject of the information,
or where there is a reasonable basis to believe such information could be
utilized (either alone or with other information that is, or should reasonably
be known to be, available to predictable recipients of such information) to
reveal the identity of that individual.
§ 1231. Use of Protected Health Information.
(1)
Protected
health information collected by the Department of Health and Social Services
and/or its agencies shall be used solely for legitimate public health purposes.
(2)
Non-identifiable
health information shall be used by the Department of Health and Social
Services and its agencies whenever possible consistent with the accomplishment
of legitimate public health purposes.
(3)
Any
use of protected health information permitted by this Subchapter shall be
limited to the minimum amount of information which the official using the
information reasonably believes is necessary to accomplish the legitimate
public health purpose.
(4)
Protected
health information shall not be used by the State for commercial purposes.
(5)
Protected
health information whose use no longer furthers the legitimate public health
purpose for which it was acquired shall be expunged.
§ 1232. Disclosure of
Protected Health Information.
(1)
General
Privacy Protection. Protected health
information is not public information as defined at 29 Del. C. § 10002,
and may not be disclosed without the informed consent of the individual (or the
individual’s lawful representative) who is the subject of the information,
except as expressly provided by statute.
Whenever disclosure of protected health information is made pursuant to
this Subchapter, such disclosure shall be accompanied by a statement concerning
the Department of Health and Social Services’ disclosure policy.
(2)
Scope
of Disclosure. Protected health information
shall be disclosed with the informed consent of the individual who is the
subject of the information to any person and for any purpose for which the
disclosure is authorized pursuant to informed consent.
(3)
Non-identifiable
Information. Any disclosure of
protected health information permitted by this Subchapter shall be disclosed in
a non-identifiable form whenever possible, consistent with the accomplishment
of legitimate public health purposes, except when the disclosure is authorized
through the informed consent of the person who is the subject of the
information. Any disclosures of
protected health information permitted by this Subchapter shall also be limited
to the minimum amount of information which the person making the disclosure
reasonably believes is necessary to accomplish the purpose of the disclosure,
except when the disclosure is authorized through the informed consent of the
individual who is the subject of the information.
(4)
Disclosure
Without Informed Consent. Protected
health information may be disclosed without the informed consent of the
individual who is the subject of the information where such disclosures are
made:
(a)
directly
to the individual;
(b)
to
appropriate federal agencies or authorities as required by federal or State
law;
(c)
to
health care personnel to the extent necessary in an emergency to protect the
health or life of the person who is the subject of the information from
serious, imminent harm;
(d)
to
the public safety authority during a public health emergency; or
(e)
pursuant
to a court order to avert a clear danger to an individual or the public health.
(5)
Deceased
Individuals. Nothing in this Subchapter
shall prohibit the disclosure of protected health information:
(a)
in
a certificate of death, autopsy report, or related documents prepared under
applicable laws or regulations;
(b)
for
the purposes of identifying a deceased individual;
(c)
for
the purposes of determining a deceased individual’s manner of death by a
medical examiner; or
(d)
to
provide necessary information about a deceased individual who is a donor or
prospective donor of an anatomical gift.
(6)
Informed
Consent by Others. When an individual
who is the subject of protected health information is not competent or is
otherwise legally unable to give informed consent for the disclosure of protected
health information, informed consent may be given by the individual’s parents,
legal guardians, or other persons lawfully authorized to make health care
decisions for the individual.
(7)
Secondary
Disclosures. No person to whom
protected health information has been disclosed pursuant to this Act shall
disclose the information to another person except as authorized by this
Subchapter. This Section shall not
apply to:
(a)
the
individual who is the subject of the information;
(b)
the
individual’s parents, legal guardians, or other persons lawfully authorized to
make health care decisions for the individual where the individual who is the
subject of the information is unable to give legal consent pursuant to
paragraph (6) of this subsection; or
(c)
any
person who is specifically required by federal or State law to disclose the
information.”.
Section 13. Add a new
subchapter to Title 20, Chapter 31 of the Delaware Code, to read as follows:
“Subchapter V. Public Health Emergencies.
§ 3131. Findings.
The State of Delaware finds
as follows:
(a)
Government
must do more to protect the health, safety, and general well being of the
general public.
(b)
New
and emerging dangers, including emergent and resurgent infectious diseases and
incidents of civilian mass casualties, pose serious and immediate threats.
(c)
A
renewed focus on the prevention, detection, management, and containment of
public health emergencies is called for.
(d)
Emergency
health threats, including those caused by bioterrorism and epidemics, require
the exercise of extraordinary government functions.
(e)
Delaware
must have the ability to respond, rapidly and effectively, to potential or
actual public health emergencies.
(f)
The
exercise of emergency health powers must promote the common good.
(e)
Emergency
health powers must be grounded in a thorough scientific understanding of public
health threats and disease transmission.
(f)
The
rights of people to liberty, bodily integrity, and privacy must be respected to
the fullest extent possible consistent with the overriding importance of the public’s
health and security.
(g)
Guided
by principles of justice, it is the duty of this State to act with fairness and
tolerance towards individuals and groups.
(h)
This
subchapter is necessary to protect the health and safety of the citizens of
this State.
§ 3132. Definitions.
The following terms shall
have the indicated meanings when used in this subchapter.
(a) ‘Bioterrorism’ is the intentional use of any microorganism,
virus, infectious substance, or biological product that may be engineered as a
result of biotechnology, or any naturally occurring or bioengineered component
of any such microorganism, virus, infectious substance, or biological product,
to cause death, disease, or other biological malfunction in a human, an animal,
a plant, or another living organism in order to influence the conduct of
government or to intimidate or coerce a civilian population.
(b) ‘Chain of custody’ means the methodology of tracking specimens
for the purpose of maintaining control and accountability from initial
collection to final disposition of the specimens and providing for
accountability at each stage of collecting, handling, testing, storing, and
transporting the specimens and reporting test results.
(c) ‘Contagious disease’ is an infectious disease that can be
transmitted from person to person, animal to person, or insect to person.
(d) ‘Health care facility’ means any non‑federal
institution, building, or agency or portion thereof, whether public or private
(for‑profit or nonprofit) that is used, operated, or designed to provide
health services, medical treatment, or nursing, rehabilitative, or preventive
care to any person or persons. This
includes, but is not limited to: ambulatory surgical facilities, home health
agencies, hospices, hospitals, infirmaries, intermediate care facilities,
kidney treatment centers, long term care facilities, medical assistance
facilities, mental health centers, outpatient facilities, public health
centers, rehabilitation facilities, residential treatments facilities, skilled
nursing facilities, and adult day‑care centers. The term also includes, but is not limited to, the following
related property when used for or in connection with the foregoing:
laboratories; research facilities; pharmacies; laundry facilities; health
personnel training and lodging facilities; patient, guest, and health personnel
food service facilities; and offices and office buildings for persons engaged
in health care professions or services.
(e) ‘Health care provider’ means any person or entity who provides
health care services including, but not limited to, hospitals, medical clinics
and offices, special care facilities, medical laboratories, physicians,
pharmacists, dentists, physician assistants, nurse practitioners, registered
and other nurses, paramedics, emergency medical or laboratory technicians, and
ambulance and emergency medical workers.
(f) ‘Infectious disease’ is a disease caused by a living organism
or other pathogen, including a fungus, bacillus, parasite, protozoan, or
virus. An infectious disease may, or
may not, be transmissible from person to person, animal to person, or insect to
person.
(g) ‘Infectious waste’ means:
(i) ‘biological waste’ which includes blood and blood products,
excretions, exudates, secretions, suctioning and other body fluids, and waste
materials saturated with blood or body fluids;
(ii) ‘cultures and stocks,’ which includes etiologic agents and
associated biologicals, including specimen cultures and dishes and devices used
to transfer, inoculate, and mix cultures, wastes from production of biologicals
and serums, and discarded live and attenuated vaccines;
(iii) ‘pathological waste,’ which includes biopsy materials and all human
tissues, anatomical parts that emanate from surgery, obstetrical procedures,
autopsy and laboratory procedures and animal carcasses exposed to pathogens in
research and the bedding and other waste from such animals, but does not
include teeth or formaldehyde or other preservative agents; and
(iv) ‘sharps,’ which includes needles, IV tubing with needles attached,
scalpel blades, lancets, breakable glass tubes, and syringes that have been
removed from their original sterile containers.
(h) ‘Isolation’ is the physical separation and confinement of an
individual or groups of individuals who are infected or reasonably believed to
be infected with a contagious or possibly contagious disease from non-isolated
individuals, to prevent or limit the transmission of the disease to
non-isolated individuals.
(i) ‘Mental health support personnel’ includes, but is not limited
to, psychiatrists, psychologists, social workers, and volunteer crisis
counseling groups.
(j) ‘Protected health information’ means any information, whether
oral, written, electronic, visual, pictorial, physical, or any other form, that
relates to an individual’s past, present, or future physical or mental health
status, condition, treatment, service, products purchased, or provision of
care, and that reveals the identity of the individual whose health care is the
subject of the information, or where there is a reasonable basis to believe
such information could be utilized (either alone or with other information that
is, or should reasonably be known to be, available to predictable recipients of
such information) to reveal the identity of that individual.
(k) ‘Public health authority’ means the Secretary of Health and
Social Services or such person as he/she may designate with the Governor’s
consent.
(l)
A
‘public health emergency’ is an occurrence or imminent threat of an illness or
health condition that:
(i) is believed to be
caused by any of the following:
(A) bioterrorism;
(B) the appearance of a novel or
previously controlled or eradicated infectious agent or biological toxin;
(C)
a
chemical attack or accidental release;
and
(ii)
poses a high probability of any of the following harms:
(A) a large number of deaths in
the affected population;
(B) a large number of serious or
long-term disabilities in the affected population; or
(C) widespread exposure to an
infectious or toxic agent that poses a significant risk of substantial future
harm to a large number of people in the affected population.
(m)
‘Public
safety authority’ means the Director of the Delaware Emergency Management
Agency or such other person as the Governor may designate.
(n)
‘Quarantine’
is the physical separation and confinement of an individual or groups of
individuals, who are or may have been exposed to a contagious or possibly
contagious disease and who do not show signs or symptoms of a contagious
disease, from non-quarantined individuals, to prevent or limit the transmission
of the disease to non-quarantined individuals.
(o)
‘Specimens’
include, but are not limited to, blood, sputum, urine, stool, other bodily
fluids, wastes, tissues, and cultures necessary to perform required tests.
(p)
‘Tests’
include, but are not limited to, any diagnostic or investigative analyses
necessary to prevent the spread of disease or protect the public’s health,
safety, and welfare.
§ 3133. Declaration of Public
Health Emergency.
(a) If the Governor has specifically designated a State of
Emergency declared pursuant to Section 3115 of this Title as a ‘public health
emergency’, the public safety authority shall, in consultation with the public
health authority, coordinate all matters pertaining to the public health
emergency response of the State. The public safety authority shall have primary
jurisdiction, responsibility, and authority for:
(1)
planning
and executing public health emergency assessment, mitigation, preparedness
response, and recovery for the State;
(2)
determining
necessary steps to be taken with respect to dangerous facilities and materials;
(3)
determining
which persons shall have access to and control of facilities, supplies, and
property;
(4)
making
determinations with respect to the proper disposal of human remains and
infectious waste;
(5)
making
determinations as to the sale, distribution, access to, and regulation of
medical supplies;
(6)
coordinating
public health emergency response between State and local authorities;
(7)
collaborating
with relevant federal government authorities, elected officials of other
states, private organizations, or private sector companies;
(8)
coordinating
recovery operations and mitigation initiatives subsequent to public health
emergencies; and
(9)
organizing
public information activities regarding State public health emergency response
operations.
(b)
After
the declaration of a state of public health emergency, the public safety
authority shall consult with the public health authority in the execution of
all of its duties described in this subchapter.
§ 3134. Control of Health
Care Supplies.
The public health authority
may purchase and distribute anti‑toxins, serums, vaccines, immunizing
agents, antibiotics, and other pharmaceutical agents or medical supplies that
it deems advisable in the interest of preparing for or controlling a public health
emergency, without any additional legislative authorization.
§ 3135. Destruction of
Property.
To the extent practicable
consistent with the protection of public health, prior to the destruction of
any property under this Subchapter, the public safety authority or public
health authority shall institute appropriate civil proceedings against the
property to be destroyed in accordance with the existing laws and rules of the
Superior Court or any such rules that may be developed by the Superior Court for
use during a state of public health emergency.
Any property acquired by the public safety authority or public health
authority through such proceedings shall, after entry of the decree, be
disposed of by destruction as the Court may direct. The public safety authority’s determination or public health
authority’s determination as to the practicability of instituting civil
proceedings prior to the destruction of property during a State of Emergency
shall not be subject to judicial injunction.
§ 3136. Control of
Individuals During Public Health Emergency.
If the Governor has
specifically designated a State of Emergency declared pursuant to Section 3115
of this Title as a ‘public health emergency’, the public safety authority shall
use every available means to prevent the transmission of infectious disease and
to ensure that all cases of infectious disease are subject to proper control
and treatment.
§ 3137. Medical Examination
and Testing During Public Health Emergency.
If the Governor has
specifically designated a State of Emergency declared pursuant to Section 3115
of this Title as a ‘public health emergency’, the following rules shall apply:
(a)
Medical
examinations or tests may be performed by any qualified person authorized to do
so by the public safety authority.
(b)
Medical
examinations or tests must not be such as are reasonably likely to lead to
serious harm to the affected individual.
(c)
The
public safety authority may isolate or quarantine, subject to Section 3138, any
person whose refusal of medical examination or testing results in uncertainty
regarding whether he or she has been exposed to or is infected with a
contagious or possibly contagious disease or otherwise poses a danger to public
health.
§ 3138. Isolation and
Quarantine During Public Health Emergency.
The following isolation and
quarantine procedures shall be in effect if the Governor has specifically
designated a State of Emergency declared pursuant to Section 3115 of this Title
as a ‘public health emergency’:
(a)
General
Authority. The public safety authority
may exercise, for such period as the State of public health emergency exists,
the following emergency powers over persons:
(1)
to
establish and maintain places of isolation and quarantine;
(2)
to
isolate and quarantine individuals subject to the procedures enumerated in this
Section; and
(3)
to
require isolation or quarantine of any person by the least restrictive means
necessary to protect the public health, subject to the other provisions of this
Section. All reasonable means shall be
taken to prevent the transmission of infection among the isolated or
quarantined individuals.
(b)
Standard
for Quarantine or Isolation.
(1)
Persons
shall be isolated or quarantined if it is determined by clear and convincing
evidence that the person to be quarantined poses a significant risk of
transmitting a disease to others with serious consequences. A person’s refusal to accept medical
examination, vaccination, or treatment pursuant to Sections 3142 and 3144 of
this Title shall constitute prima facie
evidence that said person should be quarantined or isolated.
(2)
Isolation
or quarantine of any person shall be terminated when such person no longer
poses a significant risk of transmitting a disease to others with serious
consequences.
(c)
Character
of Isolation and Quarantine Area.
(1)
To
the extent possible, the premises in which persons are isolated or quarantined
shall be maintained in safe and hygienic manners, designed to minimize the
likelihood of further transmission of infection or other harm to persons
subject to isolation or quarantine.
Adequate food, clothing, medication, and other necessities, and
competent medical care shall be provided.
(2)
Isolated
individuals must be confined separately from quarantined individuals.
(3)
The
health status of isolated and quarantined individuals must be monitored
regularly to determine if their status should change. If a quarantined individual subsequently becomes infected or is
reasonably believed to have become infected with a contagious or possibly
contagious disease, he or she must promptly be moved to isolation.
(d)
Control
of Quarantine and Isolation Area.
(1)
A
person subject to isolation or quarantine shall obey the public safety
authority’s rules and orders, shall not go beyond the isolation or quarantine
premises, and shall not put himself or herself in contact with any person not
subject to isolation or quarantine other than a physician or other health care
provider, public health authority, or person authorized to enter isolation or
quarantine premises by the public safety authority. Failure to obey these provisions shall constitute a
misdemeanor. Any person entering
isolation or quarantine premises may be isolated or quarantined.
(2)
No
person, other than a person authorized by the public safety authority, shall
enter isolation or quarantine premises. If any person enters isolation or quarantine premises without
permission of the public safety authority, that person shall be liable for a
misdemeanor. If, by reason of an unauthorized entry into an isolation or quarantine
premises, the person poses a danger to public health, he or she may be subject
to isolation or quarantine pursuant to the provisions of this Section.
(e)
Procedures
for Isolation and Quarantine. The
following procedures shall protect the due process rights of Delawareans:
(1)
The
public safety authority may petition the Superior Court for an order
authorizing the isolation or quarantine of an individual or groups of
individuals.
(2)
A
petition pursuant to subsection (i)(1) shall specify the following:
(aa)
the
identity of the individual(s) or groups of individuals subject to isolation or
quarantine;
(bb)
the
premises subject to isolation or quarantine;
(cc)
the
date and time at which isolation or quarantine commences;
(dd)
the
suspected contagious disease, if known;
(ee)
a
statement of compliance with the conditions and principles for isolation and
quarantine; and
(ff)
a
statement of the basis upon which isolation or quarantine is justified.
(3)
Ex parte orders. Before isolating or quarantining a person,
the public safety authority shall obtain a written, ex parte order from the Superior Court authorizing such
action. An ex parte order shall be requested as part of a petition filed in
compliance with paragraphs (1) through (2) of this subsection. The Court shall grant such ex parte order upon finding that there
is a reasonable likelihood that isolation or quarantine is warranted pursuant
to the provisions of this Act. A copy of the authorizing order shall be given
to the person isolated or quarantined, along with notification that the person
has a right to a hearing under this paragraph.
(4)
Temporary
quarantine or isolation pending filing of a petition. Notwithstanding the preceding subparagraphs, the public safety
authority may isolate or quarantine a person without first obtaining a written ex parte order from the Court if any
delay in the isolation or quarantine of the person would pose an immediate
threat to the public health. Following
such isolation or quarantine, the public health authority shall file a petition
pursuant to paragraphs (1) through (3) of this subsection within twenty-four
hours. If the public safety authority
exercises its powers under this subsection, it must provide a written directive
indicating the identities of the individuals or groups subject to the
directive, the premises subject to isolation or quarantine, the date and time
that the directive commences, the suspected contagious disease (if known), and
a copy of Section 3138 of this Title.
(5)
Speedy
hearing. The Court shall grant a
hearing within seventy-two hours of the filing of a petition when an individual
has been isolated or quarantined pursuant to paragraphs (3) or (4) of this
subsection.
(6)
Consolidation
of claims. The Court may order
consolidation of individual claims into a group of claims where:
(i) the number of individuals involved or to be affected is so large
as to render individual participation impractical;
(ii)
there
are questions of law or fact common to the individual claims or rights to be
determined;
(iii)
the
group claims or rights to be determined are typical of the affected
individuals’ claims or rights; and
(iv) the entire group will be
adequately represented in the consolidation, giving due regard to the rights of
affected individuals.
(f)
Relief
for Isolated and Quarantined Persons.
(1)
On
or after thirty days following a hearing as is provided for in this subparagraph,
a person isolated or quarantined pursuant to the provisions of this Section may
request in writing a Court hearing to contest his or her continued isolation or
quarantine. The hearing shall be held
within seventy‑two hours of receipt of such request, excluding Saturdays,
Sundays and legal holidays. A request
for a hearing shall not alter the order of isolation or quarantine. At the hearing, the public safety authority
must show that continuation of the isolation or quarantine is warranted pursuant
to the provisions of this Section.
(2)
A
person isolated or quarantined pursuant to the provisions of this Section may
request a hearing in the Superior Court for remedies regarding his or her
treatment and the terms and conditions of such quarantine or isolation. Upon receiving a request for either type of
hearing described in this subparagraph, the Court shall fix a date for a
hearing. The hearing shall take place
within ten days of the receipt of the request by the Court. The request for a
hearing shall not alter the order of isolation or quarantine.
(3)
If,
upon a hearing, the Court finds that the isolation or quarantine of the
individual is not warranted under the provisions of this Section, then the
person shall be released from isolation or quarantine. If the Court finds that the isolation or
quarantine of the individual is not in compliance with the provisions of
subsection (c), the Court may then fashion remedies appropriate to the
circumstances of the state of public health emergency and in keeping with the
provisions of this Act.
(g)
Additional
Due Process Protections.
(1)
A
record of proceedings before the Court shall be made and retained.
(2)
The
petitioner shall have the right to be represented by counsel or other lawful
representative, and the State shall provide counsel to indigent persons against
whom proceedings are initiated.
(3)
The
manner in which the request for a hearing is filed and acted upon will be in
accordance with the existing laws and rules of the Superior Court or any such
rules that are developed by the Courts for use during a state of public health
emergency, provided that hearings should be held by any means that will allow
all necessary persons to participate in the event that a public health
emergency makes personal appearances impractical.
§ 3139. Vaccination and
Treatment During Public Health Emergency.
If the Governor has
specifically designated a State of Emergency declared pursuant to Section 3115
of this Title as a ‘public health emergency’, the public safety authority may
exercise, for such period as the state of public health emergency exists, the
following emergency powers:
(a)
To
direct vaccination of persons as protection against infectious disease and to
prevent the spread of contagious or possibly contagious disease.
(1)
Vaccination
may be performed by any qualified person authorized to do so by the public
safety authority.
(2)
A
vaccine to be administered must not be such as is reasonably likely to lead to
serious harm to the affected individual.
(3)
To
prevent the spread of contagious or possibly contagious disease, the public
safety authority may isolate or quarantine, subject to Section 3138, persons
who are unable or unwilling for reasons of health, religion, or conscience to
undergo vaccination pursuant to this Section.
(b)
To
direct treatment of persons exposed to or infected with disease:
(1)
Treatment
may be administered by any qualified person authorized to do so by the public
safety authority.
(2)
Treatment
must not be such as is reasonably likely to lead to serious harm to the
affected individual.
(3)
To
prevent the spread of contagious or possibly contagious disease, the public
safety authority may isolate or quarantine, subject to Section 3138, persons
who are unable or unwilling for reasons of health, religion, or conscience to
undergo treatment pursuant to this Section.
§ 3140. Collection of
Laboratory Specimens; Performance of Tests During Public Health Emergency.
If the Governor has
specifically designated a State of Emergency declared pursuant to Section 3115
of this Title as a ‘public health emergency’, the public health authority may,
for such period as the state of public health emergency exists, collect
specimens and perform tests on any person or animal, living or deceased, and
acquire any previously collected specimens or test results that are reasonable
and necessary for emergency response.
(a) All specimens shall be clearly marked.
(b)
Specimen
collection, handling, storage, and transport to the testing site shall be
performed in a manner that will reasonably preclude specimen contamination or
adulteration and provide for the safe collection, storage, handling, and
transport of such specimen.
(c)
Any
person authorized to collect specimens or perform tests shall use chain of
custody procedures to ensure proper record keeping, handling, labeling, and
identification of specimens to be tested. This requirement applies to all
specimens, including specimens collected using on‑site testing kits.
(d)
Recognizing
that, during a state of public health emergency, any specimen collected or test
performed may be evidence in a criminal investigation, any business, facility,
or agency authorized to collect specimens or perform tests shall provide such
support as is reasonable and necessary to aid in a relevant criminal
investigation.
§ 3141. Confidentiality of
Medical Information.
Protected health information
gathered during a public health emergency shall be subject to the provisions of
Title 16, Subchapter III of the Delaware Code.
§ 3142. Licensing and
Appointment of Health Personnel During Public Health Emergency.
If the Governor has
specifically designated a State of Emergency declared pursuant to Section 3115
of this Title as a ‘public health emergency’, the public health authority may
exercise, for such period as the state of public health emergency exists, the following
emergency powers regarding licensing of health personnel:
(a)
To
require in-state health care providers to assist in the performance of
vaccination, treatment, examination, or testing of any individual as a
condition of licensure, authorization, or the ability to continue to function
as a health care provider in this State;
(b)
To
appoint and prescribe the duties of such out‑of‑state emergency
health care providers as may be reasonable and necessary for emergency
response.
(1) The appointment of out‑of‑state emergency health care
providers pursuant to this Section may be for a limited or unlimited time, but
shall not exceed the termination of the state of public health emergency. The public health authority may terminate
the out‑of‑state appointments at any time or for any reason
provided that any such termination will not jeopardize the health, safety, and
welfare of the people of this State.
(2) The public health authority may waive any or all licensing
requirements, permits, or fees required by the State code and applicable
orders, rules, or regulations for health care providers from other
jurisdictions to practice in this State.
(3) Any out‑of‑state emergency health care provider
appointed pursuant to this Section shall be considered a public employee under
10 Del. C. §§
4001-4002;
(c) To authorize the medical examiner to appoint and prescribe the
duties of such emergency assistant medical examiners as may be required for the
proper performance of the duties of the office.
(1)
The
appointment of emergency assistant medical examiners pursuant to this Section
may be for a limited or unlimited time, but shall not exceed the termination of
the state of public health emergency.
(2)
The
medical examiner may waive any or all licensing requirements, permits, or fees
required by the State code and applicable orders, rules, or regulations for the
performance of these duties.
(3) Any emergency assistant medical examiner appointed pursuant to
this Section shall be considered a public employee under 10 Del. C. §§ 4001-4002.
§ 3143. Public Health
Emergency Planning Commission.
The Public Health Emergency
Planning Commission (‘the Commission’) shall consist of the following voting
members:
(a)
the
Governor;
(b)
the
Speaker of the House of Representatives;
(c)
the
President Pro Tempore of the State Senate;
(d)
the
Secretary of Health and Social Services;
(e)
the
Secretary of Public Safety;
(f)
the
Secretary of the Department of Natural Resources and Environmental Control;
(g)
the
Secretary of Agriculture;
(h)
the
Adjutant General of the Delaware National Guard;
(i)
the
Chief Justice of the Delaware Supreme Court;
(j)
the
Director of the Delaware Emergency Management Agency; and
(k)
a
representative of the Delaware medical community or their designees.
The Secretary of Health and
Social Services or his or her designee shall serve as the Chair of the
Commission. The Governor shall also
appoint representatives of affected constituencies, including the medical
community, local health departments and governments, local police, fire, and
emergency medical service agencies, community health centers, and volunteer
organizations as ex officio members
of the Commission.
§ 3144. Public Health
Emergency Plan.
(a) The Commission shall, within three months of the enactment of
this legislation into law, deliver to the Governor a plan for responding to a
public health emergency, that includes provisions for the following:
(1) A means of notifying and communicating with the population
during a state of public health emergency in compliance with this Act,
including a plan that ensures that 90% of the population is covered by a Health
Alert Network;
(2) Centralized coordination of resources, manpower, and services,
including coordination of responses by State, local, and federal agencies;
(3) The location, procurement, storage, transportation, maintenance,
and distribution of essential materials, including medical supplies, drugs,
vaccines, food, shelter, and beds, including a plan (with identified personnel
to be trained) to receive and distribute critical stockpile items and manage a
mass distribution of vaccine and/or antibiotics on a twenty-four hours a day,
seven days a week basis;
(4) The continued, effective operation of the judicial system
including, if deemed necessary, the identification and training of personnel to
serve as emergency judges regarding matters of isolation and quarantine as
described in this Act;
(5) The method of evacuating populations, and housing and feeding
the evacuated populations;
(6) The identification and training of health care providers to
diagnose and treat persons with infectious diseases, including a review of
statutes, regulations, and ordinances that provide for credentialing,
licensure, and delegation of authority for executing emergency public health
measures;
(7) Guidelines for the vaccination of persons, in compliance with
the provisions of this Act;
(8) Guidelines for the treatment of persons who have been exposed
to or who are infected with diseases or health conditions caused by
bioterrorism, epidemic or pandemic disease, or novel and highly fatal infectious
agents or biological toxins, that pose a substantial risk of a significant
number of fatalities or incidents of permanent or long‑term
disability. The guidelines should
cover, but not be limited to, the following diseases: anthrax, botulism,
smallpox, plague, tularemia, and viral hemorrhagic fevers;
(9) Guidelines for the safe disposal of human remains, in
compliance with the provisions of this Act;
(10) Guidelines for the safe disposal of infectious waste, in
compliance with the provisions of this Act;
(11) Guidelines for the safe and effective management of persons
isolated, quarantined, vaccinated, or treated during a state of public health
emergency;
(12) Tracking the source and outcomes of infected persons, including
a plan to receive and evaluate urgent disease reports from all parts of the
State on a twenty-four hour a day, seven days a week basis;
(13) Ensuring that each county and city within the
State identifies the following:
(i) sites where persons can be isolated or quarantined, with such
sites complying with the provisions of this Act regarding the least restrictive
means for isolation and quarantine, and the requirements for the safety, health
and maintenance of personal dignity of those isolated or quarantined;
(ii) sites where medical supplies, food, and other essentials can
be distributed to the population;
(iii) sites where emergency workers can be housed and fed;
(iv) routes and means of transportation of people and materials;
(14)
Coordination
with other states and the federal government;
(15)
Taking
into account cultural norms, values, and traditions that may be relevant;
(16)
Distribution
of this plan and guidelines to those who will be responsible for implementing
the plan;
(17)
Development
of a plan to improve working relationships and communications between Level A
(clinical) and Level B/C laboratories (i.e. Laboratory Response Network
laboratories) as well as other public health officials;
(18)
Development
of a plan for communication systems that provide for a 24 hour a day, seven day
a week flow of critical health information between hospital emergency
departments, State and local health officials, and law enforcement;
(19)
Development
of a plan to enhance risk communication and information dissemination to
educate the public regarding exposure risks and effective public response; and
(20)
Other
measures necessary to carry out the purposes of this Act.
(b)
The
Commission shall review its plan for responding to a public health emergency
every two years.
(c)
The
Commission’s plan shall serve as a Statewide plan and a regional plan with
respect to federal bioterrorism requirements.
(d)
Persons
responsible for implementing the Commission’s plan should receive appropriate
and timely training, and the Commission’s plan should be tested on a regular
basis.
(e)
The
Commission shall establish a hospital bio-preparedness planning subcommittee,
whose composition shall include representation from DEMA, the Department of
Health and Social Services, the medical community, and local emergency medical
services.
§ 3145. Rules and
Regulations.
The public health authority
and Department of Public Safety are authorized to promulgate and implement such
rules and regulations as are reasonable and necessary to implement and
effectuate the provisions of this Subchapter.
The public health authority and public safety authority shall have the
power to enforce the provisions of this Subchapter through the imposition of
fines and penalties, the issuance of orders, and such other remedies as are
provided by law, but nothing in this Subchapter shall be construed to limit
specific enforcement powers enumerated in this Subchapter.
§ 3146. Financing and
Expenses.
(a)
If
the Governor has specifically designated a State of Emergency declared pursuant
to Section 3115 of this Title as a ‘public health emergency’, the Governor may
transfer from any fund available to the Governor in the State Treasury such
sums as may be necessary to meet the public health emergency.
(b)
Monies
so transferred shall be repaid to the fund from which they were transferred
when monies become available for that purpose, by legislative appropriation or
otherwise.
§ 3147. Liability.
(a)
If
the Governor has specifically designated a State of Emergency declared pursuant
to Section 3115 of this Title as a ‘public health emergency’, any person owning
or controlling real estate or other premises who voluntarily and without
compensation grants a license or privilege, or otherwise permits the
designation or use of the whole or any part or parts of such real estate or
premises for the purpose of sheltering persons, together with that person’s
successors in interest, if any, shall be considered a public employee under 10 Del.
C. §§ 4001-4002.
(b)
If
the Governor has specifically designated a State of Emergency declared pursuant
to Section 3115 of this Title as a ‘public health emergency’, any private
person, firm or corporation and employees and agents of such person, firm or
corporation in the performance of a contract with, and under the direction of,
the State or its political subdivisions under the provisions of this subchapter
shall be considered a public employee under 10 Del. C. §§ 4001-4002 for acts taken consistent
with this subchapter.
(c)
If
the Governor has specifically designated a State of Emergency declared pursuant
to Section 3115 of this Title as a ‘public health emergency’, any private
person, firm or corporation and employees and agents of such person, firm or
corporation, who renders assistance or advice at the request of the State or
its political subdivisions under the provisions of this subchapter shall be considered
a public employee under 10 Del. C. §§
4001-4002.
(d)
The
immunities provided in this Section shall not apply to any private person,
firm, or corporation or employees and agents of such person, firm, or
corporation whose act or omission caused, in whole or in part, the public
health emergency and who would otherwise be liable therefor.
§ 3148. Compensation.
(a)
The
State shall pay just compensation to the owner of any private facilities or
materials that are lawfully taken or appropriated by the public safety
authority or public health authority for their temporary or permanent use under
this Subchapter during a public health emergency. State compensation shall not be provided for facilities or
materials that are closed, evacuated, decontaminated, or destroyed when there
is reasonable cause to believe that they may endanger the public health. Except as otherwise indicated in this
Chapter, ‘just compensation’ shall be used in the same manner that it is used
in Title 10, Chapter 61 of the Delaware Code.
(b)
Any
action against the State with regard to the payment of compensation shall be
brought in the Superior Court of the State of Delaware in the county in which
the property is alleged to have been taken or appropriated, in accordance with
existing Superior Court rules, or any such rules that may be developed by the
Courts for use during a state of public health emergency.
(c)
The
amount of compensation shall be calculated in the same manner as compensation
due for taking of property pursuant to non‑emergency eminent domain
procedures, except that the amount of compensation calculated for confiscated
supplies or materials shall not exceed the costs incurred to produce the items.
§ 3149. Saving clause.
This Subchapter does not
explicitly preempt other State laws or regulations that preserve to a greater
degree the powers of the Governor or public health authority, provided such
laws or regulations are consistent, and do not otherwise restrict or interfere,
with the operation or enforcement of the provisions of this Subchapter. The powers assigned to the Governor, public
safety authority, and public health authority by this Subchapter supplement and
do not derogate the Governor’s powers under Subchapters III and IV of this
Title.
§ 3150. Conflicting laws.
(a)
This
Act does not restrict any person from complying with federal law or
regulations.
(b)
In
the event of a conflict between this Act and other State or local laws or
regulations concerning public health powers, the provisions of this Act
apply.”.
Section 14. Severability.
The
provisions of this Act are severable.
If any provision of this Act or its application to any person or
circumstances is held invalid in a federal or State Court having jurisdiction,
the invalidity will not affect other provisions or applications of this Act
that can be given effect without the invalid provision or application.
Section 15. The provisions of
this Act shall take effect upon signature of the Governor.
SYNOPSIS
This statute is designed to
clarify the Government’s emergency authority during public health
emergencies—authority that already exists in general form in the State’s
existing emergency powers statute. It
is also designed to specifically enumerate procedures that would be used
during a public health emergency to exercise those powers. The legislation: (a)
expands and clarifies the duties of health care providers to
report medical conditions that could lead to a public health emergency; (b) Requires pharmacists to report prescription-related events that could lead to a public health emergency; (c) Requires persons who deal with animals to report events that could lead to a public health emergency; (d) Clarifies procedures for the Division of Public Health to track potential public health emergencies; (e) Clarifies the Governor’s emergency powers in the event of a public health emergency, including the control of dangerous facilities and materials, the safe disposal of infectious materials, the safe and respectful disposal of human remains, the availability of health care supplies, and the ability to implement effective vaccination, testing, and treatment programs; (f) Establishes the procedures for quarantining and isolating individuals, with appropriate due process protections; (g) Establishes the procedures for compensation of persons whose property is damaged or confiscated during a public health emergency; (h)
Establishes
procedures for the protection of personal health information gathered during
a public health emergency; and (i) Requires the creation of a more detailed public health emergency plan. |