Cleveland Ordinances, Ohio Laws, and Federal Laws Related to or that May Be Related toCommunicable Disease Outbreaks andQuarantine/Isolation Issues (I#20480)

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INTRODUCTION

Thisoverview focuses primarily on the authority, duties, and responsibilities of government to respond to public health emergencies or threatened emergencies involving influenza/communicable disease outbreaks, epidemics, or pandemics,and to declare and enforce quarantine or isolation.

In Ohio, the boards of health of a general or city health district have primary responsibility for public health emergencies within their jurisdiction, including isolation and quarantine. This authority is subject to oversight or intervention by the State through its Department of Health (ODH). ODH has “ultimate” authority in matters of quarantine and isolation, but is required towork in cooperation with the health commissioner of the general or city health district.[1] The federal government has various laws that authorize it to act in a public health emergency as appropriate and consistent with state and local authorities.

CITY OF CLEVELAND – CHARTER AND ORDINANCES

  • Charter, Chapter 23, §114

City may enforce all laws and ordinances related to health, and shall perform and may exercise all powers provided by general law, relative to public health, to be performed and exercised by municipalities by health officers.

  • CCO §141.02 Duties of Commissioner of Health

Shall administer Health Code and see that all ordinances and rules of the City and all applicable State laws affecting the public health are properly enforced. “He shall maintain and supervise a laboratory to assist in the diagnosis of communicable diseases and in fixing the period of quarantine…”

  • CCO §141.12 Subdivision of Communicable Diseases

Establishes subdivision of communicable diseases administered by a chief subject to direction of Commissioner of Health. The subdivision’s function is to prevent the transmission of communicable diseases, perform disinfections, establish and maintainquarantine, and perform such other duties deemed necessary for the prevention and control of epidemics.

  • CCO §203.01 Investigations; Remedial Measures

Permits Commissioner of Environmental Health or any other authorized City officer/employee to investigate and take measures necessary to abate nuisance.

  • CCO §203.02 Notice to Abate; Exception

When nuisance affects or endangers the public health, Commissioner of Environmental Health or authorized officer/employee shall give notice to property owner or person in charge to abate the nuisance. If no owner/person is charge can be found within a reasonable time or immediate abatement is needed, the Commissioner need not wait to abate the nuisance.

STATE OF OHIO LAWS[2]

A. GENERAL

  • RC §301.24 County health department or agency.

Provides authority to create a county health department by charter. In accordance with the county charter, the county health department shall exercise all powers and perform all duties vested in or imposed upon authorities of city or general health districts.

  • RC §307.61 Institutions subject to inspection of commissioners or board of health.

Each public or private hospital,reformatory home, house of detention, private asylum, and correctional institution shall be open at all times to inspection by board of county commissioners or the board of health of the general health district or the city health district in which the institiution is located.

  • RC §715.37 Health; contagious diseases; hospitals.

Provides that any municipal corporation may “[s]ecure the inhabitants of the municipal corporation from the evils of contagious, malignant, and infectious diseases…”

  • RC §3313.67 Immunization of pupils to prevent spread of diseases….

The board of education of a city, exempted village, or local school district may make and enforce rules to secure immunization of, and to prevent spread of, communicable diseases among pupils. The board of health, municipal corporation, or township, upon application by the board of education, must provide, at public expense, immunizations to pupils not so provided by parents or guardians.

  • RC §3313.68 Employment of medical personnel….

Boards of education shall cooperate with boards of health in the prevention and control of epidemics.

  • RC 3313.74 Certain institutions…not permitted near schools.

Prohibits establishment of any institution to house or care for persons suffering from communicable disease, as defined by the director of health, within 2000feet of any public, private, or parochial school.

  • RC §3701.03 General duties of director of health.[3]

The director of public health may designate employees of ODH, and, during a public health emergency, others persons to administer the health and sanitation laws and rules of the ODH on the director’s behalf. This section cannot be used to authorize any action that prevents the fulfillment of duties or impairs the exercise of authority established by law for any other person or entity.

  • RC §3701.07 …Reporting of information….

The public health council may establish rules requiring hospitals and dispensaries to report, among other specified information, any other information that the council considers relevant to the safety of patients served by the institution.

  • RC §3701.072 Preparedness and capacity of trauma center to respond to disasters, mass casualties, and bioterrorism.

Public health council may require trauma centers to report on their preparedness and capacity to respond to disasters, mass casualties, and bioterrorism.

  • RC §3701.13 Powers of department.

ODH shall have supervision of all matters relating to preservation of the life and health and has ultimate authority in matters of quarantine and isolation, which it may declare and enforce, and modify, relax, or abolish when established. It may make special or standing orders or rules for preventing the spread of contagious or infectious diseases. Whenever possible, the department shall work in cooperation with the health commissioner (or his/her equivalent) in a general or city health district. It may make and enforce orders in local matters when an emergency exists, or when the board of health of a general or city health district neglects or refuses to act with sufficient promptness or efficiency.

  • RC §3701.14 Special duties of director of health.

The director of ODH shall investigate causes of disease or illness including contagious, infectious, epidemic, pandemic, or endemic conditions, and take prompt action to control and suppress it. The director may make and execute orders necessary to protect people against diseases of lower animals. Information collected during an investigation, generally, is confidential except when director determines that release is necessary to avert or mitigate clear threat to individual or to the public health. In this event, release is restricted to person needing to know and only to extent necessary.

  • RC §3701.146 Powers and duties regarding tuberculosis; public health councilstandards.[4]

The director shall maintain registries of hospitals and other healthcare providers the director shall refer persons to who contact ODH regarding possible exposure to TB; engage in TB surveillance activities and maintain a registry to record incidences of TB in the state; and, may appoint physicians to act as consultants to advise physicians and other health care practitioners participating in TB control activities. The public health council shall establish standards regarding TB screenings, examinations, treatment, preventing infection of others by infected individuals, lab testing, etc. The rules shall apply to county or district tuberculosis control units, physicians that examine and treat individuals for TB, and labs performing TB testing.

  • RC §3701.16 Purchasing, storing, and distribution of items needed for public health emergencies.

The director of health may purchase, store, and distribute antitoxins, serums, vaccines, immunizing agents, antibiotics, and other pharmaceutical agents or medical supplies to prepare for or respond to a public health emergency.

  • RC §3701.201 Reporting of events that might be caused by bioterrorism or certain other causes.

The public health council is to adopt rules requiring certain health-related entities to report events that may be caused by bioterrorism, epidemic or pandemic disease, or established or novel infectious agents or biological or chemical toxins posing a risk of human fatality or disability.

  • RC §3701.352 Violation of rule or order prohibited.

No person shall violate any rule that the public health council, director of health, or ODH adopts or any order the director or ODH issues under RC Chapter 3701 to prevent a threat to the public caused by a pandemic, epidemic, or bioterrorism event.

  • RC §3701.56 Enforcement of rules and regulations.

The boards of health of a general or city health district, police officers, sheriffs, and others shall enforce the quarantine and isolation orders, and the rules adopted by ODH.

  • RC §3701.57 Prosecutions and proceedings; injunctive or other relief.

Authorizes the director of health, the board of health of a general or city health district, or any person charged with enforcing the rules of the ODH (under Chapter 3701), to petition the court of common pleas in which the offense is alleged to be occurring. The court may grant injunctive or other appropriate relief as the equities of the case require.

  • RC §3701.81 Spreading contagion.

A person who knows or has reasonable cause to know he/she is suffering from a dangerous, contagious disease, shall take reasonable measures to prevent exposing him/herself to others. A person having charge of or care of a person known or reasonably known by him/her to have a dangerous, contagious disease, shall take reasonable measures to protect others from exposure and to inform health authorities. A person in charge of a public conveyance or place of accommodation, amusement, resort, or trade, who knows or has reasonable cause to believe that a person using the conveyance or place has been or is being exposed to a dangerous, contagious disease, shall take reasonable measures to protect the public and to inform health authorities.

  • RC §3707.01 Powers of board; abatement of nuisances.

The board of health of a City or general health district shall abate and remove all nuisances within its jurisdiction.

  • RC §3707.02 Proceedings when order of board is neglected or disregarded.

Authorizes the board of health of a general health district to prosecute a refusal to obey an abatement of a nuisance.

  • RC §3707.021 Injunction.

Authorizes the board of health of a general health district to seek an injunction in the court of common pleas when its order to abate a nuisance is not complied with.

  • RC §3707.03 Correction of nuisance or unsanitary. conditions on school property.

The board of health of a city or general health district may remove or correct all conditions detrimental to health or well-being found upon school property by serving an order upon the board of education for the abatement of the nuisance or condition.

RC §3707.04 Quarantine regulations.

In times of epidemic, threatened epidemic, or when a dangerous communicable disease is unusually prevalent, the board of health of a city, after a personal investigation, may impose quarantine on vessels, railroads, or other public or private vehicles.

  • RC §3707.05 Board must secure approval of department of health in certain cases.

City board of health shall not close or prohibit travel on public highways, interfere with the official duties of public officers not afflicted or directly exposed to a contagious or infectious disease, or establish a quarantine of one municipal corporation or township against another municipal corporation or township without the permission of the department of health.

  • RC §3707.07 Complaint concerning prevalence of disease; inspection by health commissioner.

Upon a complaint or a reasonable belief that an infectious or contagious disease exists in a house or other locality, the city board of health/general health district shall have the site inspected by its health commissioner. If the disease exists, the board may send the person(s) diseased to a hospital or other place provided for such person(s), may restrain the person(s) exposed from interaction with others, and prohibit ingress/egress to/from the premises.

  • RC §3707.08 Isolation of persons exposed to communicable disease; placarding of premises.

When a person known to be exposed to a communicable disease declared quarantinable by the city board of health or department of health is reported, the board shall restrict the person to his place of residence or other suitable place, prohibit entrance to or exit from the place without the board’s permission, and enforce any restrictive measures prescribed by the department.

When the person is required by the board or department of health to be isolated, the board shall at once separate the person from others in the premises.

The board shall place a placard in a prominent place at the premises identifying the name of the disease.

No person isolated or quarantined by a board shall leave the premises without the written permission of the board.

  • RC §3707.09 Board may employ quarantine guards.

The board of health of a city/general health district may employ persons to execute its orders and properly guard any house or place containing a quarantined person.

  • RC §3707.14 Maintenance of persons confined in quarantined house.

The board of health of a city/general health district shall provide necessities of life for persons confined in a house due to quarantine for contagious diseases. Person quarantined responsible for cost, unless unable to pay, and, when not, the municipal corporation responsible for cost.

  • RC §3707.16 Attendance at gatherings by quarantined person prohibited.

No person isolated of quarantined for a communicable disease shall attend any public, private, or parochial school or college, Sunday school, church, or any other public gathering until released from isolation or quarantine by the board.

  • RC §3707.21 Contagious disease in public institution; temporary building.

When cholera, yellow fever, diphtheria, scarlet fever, or other dangerous, contagious, or infectious disease appears in a municipal correctional facility, the manager of the facility shall at once isolate the persons affected.

  • RC §3707.22 Removal of affected or exposed persons from public institution to hospital.

Trustees/managers of correctional institution may remove persons affected with or exposed to diseases mentioned in RC §3707.21 to a hospital or other place upon an order from the court that imposed the sentence.

  • RC §3707.26 Board shall inspect schools and may close them.

During an epidemic or threatened epidemic, or when a dangerous communicable disease is unusually prevalent, the board may close any school and prohibit public gatherings for as long as necessary.

  • RC §3707.30 Care and control of hospital; removal of persons to hospital.

When a person suffering from a dangerous contagious disease is found in a hotel, lodging-house, boardinghouse, tenement house, or other public place in the municipal corporation, the board, if it deems it necessary for the protection of the public health, may remove the person to a hospital.

  • RC §3707.31 Establishment of quarantine hospital.

A municipal corporation may establish a quarantine hospital within or without its limits. When great emergency exists, the board of health of a city/general health district may seize, occupy, and temporarily use for a quarantine hospital a suitable vacant house or building within its jurisdiction.

  • RC §3707.32 Erection of temporary buildings by board; destruction of property.

The board of health of a city/general health district may erect temporary wooden buildings or field hospital necessary for the isolation or protection of persons or freight thought to be infected, and may employ nurses, physicians, and laborers to operate them, and sufficient police to guard them. The board may disinfect, renovate, or destroy bedding, clothing, or other property when deemed necessary or a reasonable precaution against the spread of contagious or infectious diseases.

  • RC §3707.34 Authority of health commissioner regarding quarantine and isolation provisions.

The health commissioner of a general or city health district may act on behalf of the board in administering RC sections 3707.04 to 3707.32 regarding quarantine and isolation if the commissioner acts pursuant to a policy the board adopts as described in this section. Each board of health shall adopt a policy specifying the actions a health commissioner may take pursuant to this section.

B. STATE LAWS SPECIFIC TO TUBERCULOSIS

For many years, control of tuberculosis was largely left up to local health boards/departments under Ohio law. In 2000, the Ohio General Assembly repealed many antiquated tuberculosis control laws and enacted laws that identify the county of the district to be served or a “tuberculosis control unit” designated by the county board of commissioners as the entity responsible for tuberculosis control. These laws are contained in Ohio Revised Code Sections 339.71 to 339.89.

Under these laws, each county must designate a county tuberculosis (TB) control unit or enter into an agreement with other counties for a jointly designated TB control unit. The county can elect to designate, among others, a board (or department) of health of a City or health district as its TB control unit or a hospital under contract with the county.[5] The TB control unit must accept its designation and fulfill its duties under State law.[6]

Tuberculosis treatment responsibilities of the TB control unit are limited to cases of “active tuberculosis.”[7] Active TB is defined[8] as TB, regardless of communicability status that has been demonstrated by clinical, bacteriological, or radiographic evidence, to be present in a person who has not completed the appropriate treatment. It can include pulmonary and extra pulmonary TB. The TB control unit is required to treat all active cases regardless of ability to pay. The county is the payer of last resort.[9]

Physicians are required to report confirmed cases of TB to the county or TB control unit. Administrators of hospitals, clinics or other facilities, and labs performing TB tests, must also report to the county or TB control unit confirmed or suspected TB in individuals. Any person suspecting an individual has TB may report it to the TB control unit.[10] The county/TB control unit must notify the Ohio Department of Health (ODH) of all reports of suspected of confirmed cases of TB.[11] When the county/TB control unit receives a report, it must investigate within three working days.[12] All information gathered must be kept confidential by the county/TB control unit and the ODH except to the extent necessary to control TB.[13]

An individual with active TB is required to complete a TB treatment regimen and to follow the county/TB control unit’s directions regarding protecting against spread of the disease, including submitting to hospitalization.[14] The TB control unit may issue an order compelling a person with TB to comply.[15] If the person does not comply with the order, the county/TB control unit may apply to the probate court for an injunction prohibiting the person from violating the unit’s order. If there is an immediate danger to the public health, the TB control unit may request that the injunction be issued without an opportunity for the person with TB to have a prior hearing or upon an expedited hearing with the individual present.[16] If the person with TB does not comply with the court’s injunction, the county/TB control unit may ask the probate court to grant an order permitting the unit to detain the person in a hospital for examination or treatment for TB.[17]