Iowa Administrative Code
Agency 641 - PUBLIC HEALTH DEPARTMENT
Chapter 1 - REPORTABLE DISEASES, POISONINGS AND CONDITIONS, AND QUARANTINE AND ISOLATION
Rule 641-1.9 - Quarantine and isolation
Universal Citation: IA Admin Code 641-1.9
Current through Register Vol. 46, No. 19, March 20, 2024
(1) Examination, testing, and treatment of quarantinable diseases.
a. A health care provider who attends an
individual with a suspected or active quarantinable disease shall make all
reasonable efforts in accordance with guidance from a local health department
or the department to examine or cause all household and other known contacts of
the individual to be examined by a health care provider. The health care
provider shall promptly report to the department the results of such
examination. If the individual refuses or is unable to undergo examination, the
health care provider shall promptly report such information to the
department.
b. When required by the
department, all contacts of an individual who has a suspected or active
quarantinable disease, including all adult and minor contacts, shall submit to
a diagnostic test or tests or other monitoring. If any suspicious abnormality
is found, steps satisfactory to the department shall be taken to refer the
individual promptly to a health care provider or appropriate medical facility
for further evaluation and, if necessary, treatment. The department or the
referring health care provider or facility shall notify the receiving health
care provider or facility of the suspicious abnormality. When requested by the
department, a health care provider shall report the results of the examination
of a contact to the case or suspected case or incident. If an individual with a
suspected or active quarantinable disease fails to comply with a department
order to submit to diagnostic testing or monitoring, such individual may be
ordered to be quarantined or isolated as determined by the
department.
c. Upon order of the
department or local board of health, an individual with a suspected or active
quarantinable disease shall not attend the workplace or school and shall not be
present at other public places until the individual receives the approval of
the department or a local board of health to engage in such activity. Upon
order of the department or local board of health, employers, schools and other
public places shall exclude an individual with a suspected or active
quarantinable disease. An individual may also be excluded from other premises
or facilities if the department or a local board of health determines the
premises or facilities cannot be maintained in a manner adequate to protect
others against the spread of the disease.
d. A person diagnosed with or clinically
suspected of having infectious tuberculosis shall complete voluntary treatment
until, in the opinion of the health care provider or the state public health
medical director and epidemiologist, the person's tuberculosis is cured or such
person is no longer a threat to public health. If such person refuses to
complete the course of voluntary treatment, the department or local board of
health may issue an order compelling mandatory treatment. Such order shall
include the identity of the person subject to the mandatory treatment order, a
description of the treatment ordered, the medical basis upon which the
treatment is ordered, and a description of the potential medical and legal
consequences of violating such order. A person who violates a mandatory
treatment order may be subject to the penalties provided in Iowa Code section
135.38 or
137.117
and may be placed under mandatory quarantine or isolation in accordance with
the provisions of this chapter.
e.
A person diagnosed with extrapulmonary tuberculosis or clinically suspected of
having infectious tuberculosis who fails to comply with a health care
provider's recommendation for diagnostic testing may be ordered to undergo
diagnostic testing by the department or local board of health. Such order shall
include the identity of the person subject to mandatory diagnostic testing, a
description of the diagnostic testing ordered, the medical basis upon which the
diagnostic testing is ordered, and a description of the potential medical and
legal consequences of violating such order. A person who violates a mandatory
diagnostic testing order may be subject to the penalties provided in Iowa Code
section
135.38 or
137.117
and may be placed under mandatory quarantine or isolation in accordance with
the provisions of this chapter.
(2) General provisions.
a.
Voluntary confinement.
Prior to instituting mandatory isolation or quarantine pursuant to this rule,
the department or a local board of health may request that an individual or
group of individuals voluntarily confine themselves to a private home or other
facility.
b.
Quarantine and
isolation. The department and local boards of health are authorized to
impose and enforce quarantine and isolation restrictions. Quarantine and
isolation shall rarely be imposed by the department or by local boards of
health. If a quarantinable disease occurs in Iowa, individuals with a suspected
or active quarantinable disease and contacts to the case may be quarantined or
isolated as the particular situation requires. Any quarantine or isolation
imposed by the department or a local board of health shall be established and
enforced in accordance with this rule.
(3)Conditions and principles. The department and local boards of health shall adhere to all of the following conditions and principles when isolating or quarantining individuals or a group of individuals:
a. The
isolation or quarantine shall be by the least restrictive means necessary to
prevent the spread of a communicable or possibly communicable disease to others
and may include, but not be limited to, confinement to private homes, other
private premises, or public premises.
b. Isolated individuals shall be confined
separately from quarantined individuals.
c. The health status of isolated or
quarantined individuals shall be monitored regularly to determine if the
individuals require further or continued isolation or quarantine.
d. If a quarantined individual subsequently
becomes infected or is reasonably believed to have become infected with a
communicable or possibly communicable disease, the individual shall be promptly
removed to isolation.
e. Isolated
or quarantined individuals shall be immediately released when the department or
local board of health determines that the individuals pose no substantial risk
of transmitting a communicable or possibly communicable disease.
f.The needs of isolated or quarantined
individuals shall be addressed in a systematic and competent fashion including,
but not limited to, providing adequate food; clothing; shelter; means of
communicating with those in and outside of isolation or quarantine; medication;
and competent medical care.
g. The
premises used for isolation or quarantine shall be maintained in a safe and
hygienic manner and shall be designed to minimize the likelihood of further
transmission of infection or other harm to isolated or quarantined
individuals.
h. To the extent
possible, cultural and religious beliefs shall be considered in addressing the
needs of individuals in isolation or quarantine premises and in establishing
and maintaining the premises.
(4) Isolation and quarantine premises.
a. If deemed appropriate
by the department, sites of isolation or quarantine shall be prominently
placarded with isolation or quarantine signs prescribed and furnished by the
department and posted on all sides of the building wherever access is
possible.
b. An individual subject
to isolation or quarantine shall obey the rules and orders of the department or
the local board of health and shall not go beyond the isolation or quarantine
premises unless expressly authorized to do so by the order.
c. The department or a local board of health
may authorize physicians, health care workers, or others access to individuals
in isolation or quarantine as necessary to meet the needs of isolated or
quarantined individuals.
d. No
individual, other than an individual authorized by the department or a local
board of health, shall enter isolation or quarantine premises. If the
department has requested the assistance of law enforcement in enforcing the
isolation or quarantine, the department shall provide law enforcement personnel
with a list of individuals authorized to enter the isolation or quarantine
premises.
e. Any individual
entering an isolation or quarantine premises with or without authorization of
the department or a local board of health may be isolated or quarantined
pursuant to this rule.
(5) Isolation and quarantine by local boards of health
a. A local board of
health may:
(1) Isolate individuals who are
presumably or actually infected with a quarantinable disease;
(2) Quarantine individuals who have been
exposed to a quarantinable disease;
(3) Establish and maintain places of
isolation and quarantine; and
(4)
Adopt emergency rules and issue orders as necessary to establish, maintain, and
enforce isolation or quarantine.
b. Isolation and quarantine undertaken by a
local board of health shall be accomplished according to the rules and
regulations of the local board of health so long as such rules are not
inconsistent with this chapter.
(6) Isolation and quarantine by the Iowa department of public health.
a.
Authority.
(1) The
department, through the director, the department's medical director, or the
director's or medical director's designee, may:
1. Isolate individuals or groups of
individuals who are presumably or actually infected with a quarantinable
disease; and
2. Quarantine
individuals or groups of individuals who have been exposed to a quarantinable
disease, including individuals who are unable or unwilling to undergo
examination, testing, vaccination, or treatment, pursuant to Iowa Code section
135.144.
(2) The department may:
1. Establish and maintain places of isolation
and quarantine; and
2. Adopt
emergency rules and issue orders as necessary to establish, maintain, and
enforce isolation or quarantine.
(3) Isolation and quarantine undertaken by
the department, including isolation and quarantine undertaken by the department
in the event of a public health disaster, shall be established pursuant to
paragraph 1.9(6)"b" or "c."
b.
Temporary isolation and
quarantine without notice. The department may temporarily isolate or
quarantine an individual or groups of individuals through an oral order,
without notice, only if delay in imposing the isolation or quarantine would
significantly jeopardize the department's ability to prevent or limit the
transmission of a communicable or possibly communicable disease to others. If
the department imposes temporary isolation or quarantine of an individual or
groups of individuals through an oral order, the department shall issue a
written order as soon as is reasonably possible and in all cases within 24
hours of issuance of the oral order if continued isolation or quarantine is
necessary to prevent or limit the transmission of a communicable or possibly
communicable disease.
c.
Written order. The department may isolate or quarantine an
individual or groups of individuals through a written order issued pursuant to
this rule.
(1) The written order shall
include all of the following:
1. The identity
of the individual, individuals, or groups of individuals subject to isolation
or quarantine.
2. The premises
subject to isolation or quarantine.
3. The date and time at which isolation or
quarantine commences.
4. The
suspected communicable disease.
5.
A description of the less restrictive alternatives that were attempted and were
unsuccessful, or the less restrictive alternatives that were considered and
rejected, and the reasons such alternatives were rejected.
6. A statement of compliance with the
conditions and principles for isolation and quarantine specified in subrule
1.9(3).
7. The legal authority
under which the order is requested.
8. The medical basis upon which isolation or
quarantine is justified.
9. A
statement advising the individual, individuals, or groups of individuals of the
right to appeal the written order pursuant to subrule 1.9(7) and the rights of
individuals and groups of individuals subject to quarantine and isolation as
listed in subrule 1.9(8).
10. A
copy of this chapter and the relevant definitions.
(2) A copy of the written order shall be
provided to the individual to be isolated or quarantined within 24 hours of
issuance of the order in accordance with any applicable process authorized by
the Iowa Rules of Civil Procedure. If the order applies to a group or groups of
individuals and it is impractical to provide individual copies, the order may
be posted in a conspicuous place in the isolation or quarantine premises.
(7) Appeal from order imposing isolation or quarantine.
a.
Contested case. The
subject of a department order imposing isolation or quarantine may appeal a
written order and has the right to a contested case hearing regarding such
appeal. The subject of a department order imposing isolation or quarantine may
appeal the order by submitting a written appeal within ten days of receipt of
the written order. The appeal shall be addressed to the Department of Public
Health, Division of Epidemiology, Emergency Medical Services, and Disaster
Operations, Lucas State Office Building, Des Moines, Iowa 50319-0075. Unless
stayed by order of the director or a district court, the written order for
quarantine or isolation shall remain in force and effect until the appeal is
finally determined and disposed of upon its merits.
b.
Presiding officer. The
presiding officer in a contested case shall be the director or the director's
designee. The director or the director's designee may be assisted by an
administrative law judge in conducting the contested case hearing. The decision
of the director or the director's designee shall be the department's final
decision and is subject to judicial review in accordance with the provisions of
Iowa Code chapter 17A.
c.
Proceeding. The contested case hearing shall be conducted in
accordance with the provisions contained at 641-Chapter 173. The hearing shall
be held as soon as is practicable, and in no case later than ten days from the
date of receipt of the appeal. The hearing may be held by telephonic or other
electronic means if necessary to prevent additional exposure to the
communicable or possibly communicable disease. In extraordinary circumstances
and for good cause shown, the department may apply to continue the hearing date
for up to ten additional days on a petition filed pursuant to this rule. The
presiding officer may use discretion in granting a continuance giving due
regard to the rights of the affected individuals, the protection of the
public's health, and the availability of necessary witnesses and evidence.
Pursuant to Iowa Code sections
139A.3(2)
and
22.7(16),
the hearing shall be closed to the public at the discretion of the subject of
the order. If the hearing is closed to the public, the department's final
decision shall redact information which could lead to the identification of the
subject of the order.
d.
Judicial review. The aggrieved party to the final decision of
the department may petition for judicial review of that action pursuant to Iowa
Code chapter 17A. Petitions for judicial review shall be filed within 30 days
after the decision becomes final.
e.
Immediate judicial review of
department order. The department acknowledges that in certain
circumstances the subject or subjects of a department order may desire
immediate judicial review of a department order in lieu of proceeding with the
contested case process. The department recognizes that the procedural step of
pursuing exhaustion of administrative remedies may be inadequate for purposes
of Iowa Code section
17A.19, and the
department may consent to immediate jurisdiction of the district court when
requested by the subject or subjects of a department order and justice so
requires. Unless stayed by order of the director or a district court, the
written order for quarantine or isolation shall remain in force and effect
until the judicial review is finally determined and disposed of upon its
merits.
(8) Rights of individuals and groups of individuals subject to isolation or quarantine. Any individual or group of individuals subject to isolation or quarantine shall have the following rights:
a. The right to be represented by legal
counsel.
b. The right to be
provided with prior notice of the date, time, and location of any
hearing.
c. The right to
participate in any hearing. The hearing may be held by telephonic or other
electronic means if necessary to prevent additional exposure to the
communicable or possibly communicable disease.
d. The right to respond and present evidence
and argument on the individual's own behalf in any hearing.
e. The right to cross-examine witnesses who
testify against the individual.
f.The right to view and copy all records in
the possession of the department which relate to the subject of the written
order.
(9) Consolidation of claims. In any proceeding brought pursuant to this rule, to promote the fair and efficient operation of justice and having given due regard to the rights of the affected individuals, the protection of the public's health, and the availability of necessary witnesses and evidence, the department or a court may order the consolidation of individual claims into group claims, if all of the following conditions exist:
a. The number of individuals involved or to
be affected is so large that individual participation is impractical.
b. There are questions of law or fact common
to the individual claims or rights to be determined.
c. The group claims or rights to be
determined are typical of the affected individuals' claims or rights.
d. The entire group will be adequately
represented in the consolidation.
(10) Implementation and enforcement of isolation and quarantine.
a.
Jurisdictional issues. The department has primary jurisdiction
to isolate or quarantine individuals or groups of individuals if the
communicable disease outbreak has affected more than one county or has
multicounty, statewide, or interstate public health implications. When imposing
isolation or quarantine, the department shall coordinate with the local health
department as appropriate. If isolation or quarantine is imposed by the
department, a local board of health or local health department may not alter,
amend, modify, or rescind the isolation or quarantine order.
b.
Assistance of local boards of
health and local health departments. If isolation or quarantine is
imposed by the department, the local boards of health and the local health
departments in the affected areas shall assist in the implementation of the
isolation or quarantine order.
c.
Assistance of law enforcement. Pursuant to Iowa Code section
135.35,
all peace officers of the state shall enforce and execute a lawful department
order for isolation or quarantine within their respective jurisdictions. The
department shall take all reasonable measures to minimize the risk of exposure
to peace officers and others assisting with enforcement of an isolation or
quarantine order.
d.
Penalty. Pursuant to Iowa Code section
135.38, any individual
who knowingly violates a lawful department order for isolation or quarantine,
whether written or oral, shall be guilty of a simple misdemeanor. The
court-ordered sentence may include a fine of up to $500 and imprisonment not to
exceed 30 days.
e.
Enforcement action. The department may file a civil action in
Polk County district court or in the district court for the county in which the
individual resides or is located to enforce a department order for isolation or
quarantine. Such action shall be filed in accordance with the Iowa Rules of
Civil Procedure.
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