A.
Applicability
Provisions specified in this Section will only be applicable
in the event of a declared Extreme Public Health Emergency and then only for
the duration of the declared Extreme Public Health Emergency.
B.
Reporting Requirements
In addition to those individuals and entities required to
report notifiable diseases and conditions on a routine basis as outlined in
Section
2 and Section
11, other entities, such as schools
and businesses, may be required to report specific information as specified by
the Department pursuant to
22 MRS
§§802(1).
C.
Control Measures
In the event of a declared Extreme Public Health Emergency,
in addition to the communicable disease control measures identified in this
rule, the Department may, on the Governor's behalf, take all necessary steps to
institute the following, supplemental medical treatment and public health
control measures for the benefit of the population that either has been exposed
to or is at significant risk of exposure to the communicable disease or other
highly infectious or toxic agent or environmental hazard that caused the
Governor to declare that there exists an extreme public health
emergency.
These measures will be consistent with the national standards
for the infectious agent as established by the 20th
Edition published in 2015 Control of Communicable Diseases
Manual, or any subsequent edition, published by the American Public
Health Association. Copies of the manual may be obtained from the American
Public Health Association, 800 I Street NW, Washington, DC 20001-3710. In
addition to exercising the powers and responsibilities granted the Department
pursuant to
22 MRS
§820, the Department may undertake the
following public health measures during a period of declared extreme public
health emergency:
1. Management of
Persons
For the duration of the declared extreme public health
emergency, the Department will ensure that all necessary steps are taken to
protect the public health and safety, including:
a. Identification of exposed persons, using
all reasonable means to confirm in a timely manner any case or suspected case
of the communicable disease and will ascertain, so far as possible, all sources
of infection and exposures to the infection;
b. Tracking and follow-up of persons who are
infected or exposed, consistent with the standards referenced above or those
established for the declared extreme public health emergency by the Department
or designee;
c. Mandatory medical
examination of infected or exposed persons, making or causing all needed
examinations, including laboratory testing;
d. Mandatory medical treatment, including
vaccination or treatment with such medications as are warranted by the national
standards published by the American Public Health Association referenced in
this rule; and
e. Isolation of
cases and quarantine of exposed individuals, as indicated, concurrent and
terminal disinfection, or modified forms of these procedures as may be
necessary. Standards for isolation and quarantine will be the same as those
specified in this rule under Section
9(D)(4)
and (E) and Section
10(C)(2).
2. Isolation
and Quarantine
a. Isolation and quarantine
must:
i. Be implemented through the least
restrictive means necessary to prevent the spread of an infectious or possibly
infectious disease to others and may include confinement to private homes,
facilities and public premises;
ii.
Provide that isolated individuals be confined separately from quarantined
individuals;
iii. Include regular
monitoring to determine if the individual or group of individuals continues to
require isolation or quarantine;
iv. Require that, if a quarantined individual
subsequently becomes infected or is reasonably believed to have become infected
with the infectious disease of concern, that individual must immediately be
removed from quarantine and put in isolation;
v. Require that the premises used for
quarantine and isolation must be maintained in a safe and hygienic manner, be
designed to minimize the likelihood of further transmission of infection or
other harms to individuals quarantined or isolated and not be situated in a
physically remote location;
vi. To
the extent possible without jeopardizing the public health, family members and
members of households will be kept together, and guardians will stay with their
minor wards;
vii. Be immediately
terminated when an individual no longer poses a substantial risk of
transmitting an infectious or possibly infectious disease or condition to
others;
viii. Provide for meeting
the basic living needs of individuals who are isolated or quarantined,
including provision of competent medical care, adequate food, clothing, shelter
and means of communication between those in isolation or quarantine and those
outside these settings;
ix. Provide
accommodation of non-English speaking individuals, and to the extent possible,
for the practice of cultural and religious beliefs;
x. Provide access to legal services,
counseling and other social services; and xi. Provide to the extent possible
without jeopardizing the public health, all access to a means of work or
financial support.
b. The
Department may authorize physicians, healthcare workers and others access to
individuals in isolation or quarantine as necessary to meet the needs of
isolated or quarantined individuals. An individual entering isolation or
quarantine premises with or without authorization from the Department may be
isolated or quarantined where needed to protect the public health.
D.
Custody and Prescribed Care of Non-Compliant Persons
1. Non-Compliant Persons who are deemed by
the Department to be exposed to or at significant medical risk of transmitting
a communicable disease that poses a serious and imminent risk to public health
and safety, may, without a court order, be taken into custody and prescribed
care consistent with
22 MRS
§820 (1(B)(1) and these standards or
standards established by the Control of Communicable Diseases Manual
20th Edition, published in 2015, or any
subsequent edition, which is the official report of the American Public Health
Association. Copies of the manual may be obtained from the American Public
Health Association, 800 I Street NW, Washington, DC 20001-3710.
2. A person is exempt from such prescribed
care if alternative public health measures are available, even if those
measures are more restrictive, and if:
a. The
person demonstrates a sincere religious or conscientious objection to the care;
or
b. The person is at known risk of
serious adverse medical reaction to the care.
3. In accordance with
22 MRS
§820(2), a hearing must
be held before a court within 48 hours after a non-compliant person is subject
to prescribed care, to determine whether the person must remain in prescribed
care. Notice of the hearing must be served upon the non-compliant person within
a reasonable time before the hearing and specify the time, date and place of
the hearing; the grounds and underlying facts supporting the reason for
prescribed care, the right to appear at the hearing, right to present and
cross-examine witnesses, and the right to counsel. The previously Non-Compliant
Person may waive their right to a hearing, in writing, after receiving notice
and an opportunity to consult with an attorney. In order for a court to order
prescribed care, the Department must prove by clear and convincing evidence
that:
a. The person has been exposed or is at
significant medical risk of transmitting a communicable disease that poses a
serious imminent risk to public health or safety; and
b. There are no less restrictive
alternatives available to protect the public health and safety.
Pursuant to
22 MRS
§820(2)(D), within 24
hours of completion of the hearing, the court must enter a finding approving
prescribed care and issue an order of prescribed care not to exceed 30 days or
must dismiss the petition and order the person to be released from prescribed
care immediately.
4. A person aggrieved by a court order
prescribing care may appeal from that order to Supreme Judicial Court. The
order remains in effect pending appeal. Any findings of fact may not be set
aside unless clearly erroneous.
E.
Control of Property
To the extent authorized by the governor in accordance with
his or her authority pursuant to 37-B MRS, Chapter 13, and in conformity with
the process for obtaining or acquiring property or taking other necessary
action to abate, clean up or mitigate whatever danger was presented by the
declared extreme public health emergency pursuant to 37-B MRS, Chapter 13, and
only for the duration of the declared extreme public health emergency, the
Department will exercise the following powers as necessary to protect the
public health and safety:
a. Accessing
suspicious premises. Any agent of the Department may enter any building, vessel
or conveyance to inspect it and remove from it any person, animal, or material
affected or appearing to be affected by a Notifiable Disease or
Condition.
b. Closure of
facilities. The Department may close schools and forbid public gatherings in
schools, places of worship, and all other places in order to control spread of
Notifiable Diseases or Conditions.
c. Temporary use of Health Care Facilities
and ability to transfer patients. The Department may provide those sick with a
Notifiable Disease or Condition with medical aid and temporary hospital
accommodation, taking control of the facilities deemed needed and transferring
patients as deemed necessary.
d.
Temporary use of hotel and motel rooms and other facilities. The Department may
provide those sick with a Notifiable Disease or Condition or those exposed to a
Notifiable Disease or Condition with shelter and care, including the
distribution of medications, medical examinations and vaccination clinics, in
hotels, motels and other facilities, as deemed necessary and may procure needed
facilities for these purposes during the Extreme Public Health
Emergency.
e. Procurement of
medicines, vaccines, supplies and equipment. The Department may procure, store
or distribute antitoxins, serums, vaccines, immunizing agents, antibiotics and
other pharmaceutical agents or medical supplies that the Department determines
are advisable to control the Extreme Public Health Emergency.
f. Decontamination of buildings. The
Department may issue orders for the quarantine and disinfection of localities
and things infected or suspected of being infected by a Notifiable Disease or
Condition, and for the sanitary care of jails, state prisons, mental health
institutions, schools, hotels, motels, health facilities, public buildings, and
other premises deemed necessary to control the Extreme Public Health
Emergency.
g. Seizure and
destruction of contaminated articles. The Department may take and destroy
private property, including animals, for the purpose of controlling the Extreme
Public Health Emergency.
h.
Disposal of human and animal remains. The Department may, in consultation with
other state agencies, issue orders regarding the safe disposal of human and
animal remains, for the purpose of controlling the Extreme Public Health
Emergency.
F.
Extreme Public Health Emergency Rulemaking
The Department may adopt routine technical rules during an
Extreme Public Health Emergency, in accordance with
22 MRS
§802(3), for the
duration of that Extreme Public Health Emergency.
