WTF? Maine seeking court order to keep Ebola nurse Kaci Hickox quarantined (Maine will lose)

[morningfog]

The showdown between a nurse quarantined in Maine for treating Ebola patients and the state heated up Wednesday as officials said they were seeking a court order to prevent her from leaving her home.

“We will make it mandatory,” Mary Mayhew, Maine’s commissioner of health and human services, said at a news conference. Hours earlier the nurse, Kaci Hickox, vowed to defy the order keeping her at home while she is monitored for Ebola symptoms.

“There is no medical evidence that has been proposed or put forward by anyone that says Kaci is a risk,” Hickox’s attorney, Steven J. Hyman, told the Los Angeles Times.

“Kaci is a free individual, and how and when she acts is up to her,” Hyman said.

In an interview with NBC’s “Today” show, Hickox remained defiant.

“If the restrictions placed on me by the state of Maine are not lifted by Thursday morning, I will go to court to fight for my freedom,” she said.

Hickox spoke by Skype from Fort Kent, Maine, where she has been told to stay until the 21-day observation period ends next month. She says she remains symptom-free and therefore not a threat to anyone.

The 33-year-old nurse has become the face of a nationwide debate over treatment of healthcare workers returning from West Africa. The controversy erupted Friday when New York and New Jersey announced mandatory quarantines for such workers arriving in those states.

http://www.latimes.com/nation/nationnow/la-na-ebola-nurse-quarantine-20141029-story.html

[KamaAina]

1. "Hickox spoke by Skype from Fort Kent, Maine"

zOMFG! That's right across from Canada! It's now a worldwide epidemic! We're all gonna die!!1!!111!1!!

[vanlassie]

2. DONT TOUCH THE SKYPE!

[KamaAina]

4. Even if I reach out?

[vanlassie]

6. Double glove, at your own risk....

[CK_John]

3. Court proceeding can be jerked around for years let alone a week or 2.

[morningfog]

10. And she will win in the end. In the meantime, I hope she lives it up

where ever she chooses.

[etherealtruth]

39. Now, please do not interpet my post to mean I don't think she is correct ...

... in her assessment of her risk to the public ... she is.

(I am not an attorney, so I might well be talking out of my @$$) My fear is that public health laws are written to the effect that if the state says you are a risk ... then you are.

I understand the importance of quarantine laws .... thinking about non-compliance with medical regimes and drug resistant TB (obviously scientific basis) and this case is a complete abuse .... but I wish an attorney would weigh in.

[HereSince1628]

5. Court is the proper place for her objection.

She didn't do herself or her vocation any good by acting as if she is exceptional to rules and law.

[polichick]

7. True, on both counts.

[morningfog]

9. She is not exceptional, we are all entitled to our civil liberties.

The "rules" were unconstitutional, read: illegal.

[HereSince1628]

12. Her declared intention to defiance was an act of exceptionalism

That can now be tested in court.

She could have tested the rules in court without the threat of non-compliance.

That was unnecessary.

At present we have at least 2 MDs and 1 nurse who don't think they need to comply with state regulation.

Nancy Schneiderman and Spencer both broke compliance with voluntary isolation and this nurse threatens to violate compliance.

How does one expect states to react? They will, of course, defend state rules.

[Darb]

13. What state regulations are you refering to?

Just for informational purposes.

She is not sick.

[HereSince1628]

15. The state of Maine erected rules

as did Connecticutt, New York and New Jersey.

as it sits it appears that most of those rules followed from executive orders.

[Darb]

21. And they say they can confine someone who is not sick?

She is not yet sick. Is there a place where I can find these orders just to take a look? If not I will find them, thought you might have already read them.

[HereSince1628]

24. Unfortunately, yes they apparently do.

I am not pretending to support the rules.

I DO understand that states do need the capacity to create rules/regulations in response to what are perceived as urgent circumstances.

When the time comes that some fracker poisons water supplies I WANT state governments to be able to act to stop distribution of poisonous water.

I don't want a private water company to say the rules to protect society are stupid unscientific and not worthy of compliance...with toxic water ending up being distributed widely in society.

it's THAT possibility for responsible reaction to threats that I recognize as useful and see a need to protect.

I don't support the rules for quarantine as they are being applied, but I DO recognize the general importance of states to have the capacity to erect such rules

[morningfog]

14. What state reg? This is very much the issue. There is no legal or scientific support for this.

Again, there is no exceptionalism.

In fact, treating them differently because they are health care workers is unconstitutional. The states seem to think there is an exception. They are not quarantining non-health care workers coming from the same nations.

The court is slow. She has every right to tell the state to fuck off. It is the state that is acting illegally, not her.

[HereSince1628]

17. It ISN'T about science. It's about public health orders from state administrations

Last edited Thu Oct 30, 2014, 10:08 AM - Edit history (1)

I'm no expert on how that works in these northeastern states.

But, having worked in epidemiology for the State of Wisconsin, I am aware that state law enables administrative action in the interest of protection of public health.

I expect most states have similar language supporting their public health efforts.

I am not willing to say the rules were good ones. But I have little doubt that they were issued within the responsibility and authority of the state.

[morningfog]

19. It is about science. If there is no reasonable (read scientific) basis for the restriction of

liberty, then it is unconstitutional. I have no doubt that she will win this fight. It is in Maine's best interest to educate its policy makers and adjust accordingly.

[HereSince1628]

20. No it ISN'T about science. It's about circumstances underwhich administrations make rules

with which members of the public are obliged to comply

The rules may be based on hogwash. The rules may be based on wrong thinking (I think they ARE).

But states create provisions for reacting to perceived threats to public health rather than waiting for legislatures to act.

It's quite analogous to the much better known and understood War Powers Act at the federal level.

[morningfog]

22. Absolutely not. If there is no factual support, it is arbitrary and illegal.

There is no ambiguity with Ebola either. The science is clear for 40 years. No symptoms = no risk of infection.

[HereSince1628]

26. That's a question for a court. The reality is states have authority AND responsibility

to act in good faith to protect the public health.

Do they make mistakes when the so act? ABSOLUTELY.

But when a person makes a point of belligerent noncompliant exceptionalism to state authority, that person leaves the state with little choice.

[morningfog]

27. When the state is wrong, the noncompliance is right.

And that is where it will end up.

[HereSince1628]

30. No. What is right is a court challenge to the rule

Now, that could require an intentional violation of the rule that forces a court case that produces a ruling and all legal sequalae.

But it doesn't necessarily REQUIRE an intentional violation if a court gives standing to consideration of the legality of the rule.

What's happened is the woman went on television to declare she will not comply. That leaves the state very few degrees of freedom...

And it risks making her look like she, and other medics, are exceptional to the rules that govern the rest of us.

[adigal]

38. And I bet most Americans really resent her right now

There is very little support out there for her. I think she is very selfish.

[HereSince1628]

40. I suspect many Americans do think this is selfish exceptionalism

The MDs that violated isolation rules, and in the case of Spence outright lied about behaviors provided pretty high profile albeit limited, evidence that medics can't be trusted to conform to rules intended to protect everyone.

Governors, and state public health administrators take their responsibilities seriously. They won't respond merrily to acts of defiance of rules put in place to protect the public.

[truebluegreen]

55. On the other hand, Americans make a religion out of being selfish and exceptional

so why do they object?

[morningfog]

48. Not exceptional. Very much the same as us.

I thank her for her just actions.

[Darb]

23. If you don't mind me asking,

do you want these states to be able to confine this woman? Even though it is political posturing of the worst and most irresponsible kind? (last part IMHO)

[HereSince1628]

25. I don't agree with the rules. I agree with the states' need to make rules

to protect the public

I think Hickox can and should confront the rule in court. I think acting as if she's exceptional to the rule is bad for her and generally bad for the medical industry as it makes its members look exceptional to the rules that protect society.

[morningfog]

28. She is not acting exceptionally, she is acting constitutionally and we should all thank her.

Last edited Wed Oct 29, 2014, 09:39 PM - Edit history (1)

She is a civil disobedience heroine.

[HereSince1628]

33. IMO, her heroin-ness is open to be decided.

Clearly she is manifesting defiance.

Defiance can be right, it can also be wrong.

IMO, the entire episode could have been addressed without this level of defiance.

The nature of the order and duration for quarantine hinges on timeliness. Her attorneys could surely get rapid consideration under these parameters.

My guess is judges will defer to state pubic health authorities partly because the courts have no expertise in medicine or public health and partly because states regularly have need of imposing orders on private individuals and private institutions in the interest of public health.

[adigal]

34. I think maybe she has been taking heroin, the stupid way she's acting

But she ain't no heroine.

[KingCharlemagne]

44. At least she's not acting like a heron. Now THAT would be freaky! :) - nt

[840high]

58. I'm a nurse - she is

not my heroine.

[adigal]

36. Absolutely! If she won't keep her selfish ass at home until 21 days are up

I expect my governor to protect me from her carelessness and selfishness.

[adigal]

35. She is going to lose - big time. 80% of Americans are for a quarantine.

No one is willing to,risk a pandemic.

[treestar]

72. Is there case law stating that holding?

[KingCharlemagne]

42. Sorry, I ain't takin' no "pubic" health orders from nobody. That's a

matter strictly between my doctor and me.



Although I'm in my mid-50s, my wife says I still behave like a juvenile adolescent. Please forgive me

[riversedge]

80. Don't you think PH policies/decisions related to health are based on science??

Would seem to be the only logical way to base health decisions.

[HereSince1628]

89. They certainly should take advantage of what's known

But they (on edit: I mean policies) also have to be able to be effectively applied to circumstance.

So what do we know? Sometimes policy can take a perfectly good, if oversimplified 'fact of science/medicine' and use it for crappy policy.

For example... A susceptible person cannot get infected with a virus if there is no virus present.

That seems like a pretty airtight truth scientifically and medically. But it can be used to justify awful policy.

From that you can get travel bans, mandated isolation quarantines for Ebola suspects, etc.


Public Health policy must reach deeper than the simple scientific 'facts'. It has to develop policies whose costs/burdens are justified because they provide added protection that is more valuable than the burden.

That requires some consideration of the costs and burdens. When you are dealing with the public domain that might not relate to science at all.

For example...the argument against the travel bans and quarantines for returning medics is at least in part, that African nations in the Ebola epidemic need American medics who will be dissuaded from that work by the restrictions. Such a ban could also influence choices made by air-carriers to continue routes to those places.

That's not about science. That's about how humans, including medical professionals, are afforded opportunity and make choices. Public health policy must consider that, too.

[treestar]

71. What if it were a much more contagious disease?

Do people have civil liberties then?

It's not a matter of civil liberties. It's a matter of how contagious the disease is. And how fatal.

[Darb]

11. I have asked before and will try again, what law?

What law says that they can confine her without her being sick?

[840high]

57. Absolutely correct.

[Oktober]

95. The rule and law says that she can go where she wants...

They are trying to make an exception to her civil rights by detaining her without due process or cause...

They are going outside of the rules.. not her...

[HereSince1628]

98. Most all states allow executive/administrative orders in the interest of public health

Last edited Thu Oct 30, 2014, 02:44 PM - Edit history (1)

I can't speak to how Maine works, but it's pretty common for states to provide for the latitude and authority to impose restrictions on movement, trade etc. to protect the public.

Generally speaking, legislatures recognize they aren't nimble and lack expertise to deal with technical issues, so they construct systems that provide for experts to develop and put in place regulation. The result is that governance exists within two separate silos one for regulations (which are administrative) and one for laws (which are legislative).

Conflicts and disagreement about regulation by unelected bureaucrats are resolved by appeals both within the regulatory apparatus and in the courts.

[Oktober]

100. It's on them to prove it...

Abrogation of law and rights doesn't fly "just cause"...

At least it shouldn't and I hope the nurse enjoys her bike ride...

[HereSince1628]

103. The one place where appeal to authority works is governance.

When the government is given authority to write regulations, they can.

It'd be nice if it always worked out to be based on best available information, but that doesn't always happen.

I think the quarantine rule in Maine is much more burdensome than the protection it generates.

But regulations essentially have the weight of the state enforcement behind them, just like laws.

[bluedigger]

8. Good, let people see the process play out legally.

If there is enough political pressure in Maine for them to feel this is necessary, let them use the statutes in place to determine it's legality. This is the way to do it, not by the arbitrary exercise of power by authority. People have lost all faith in our civic institutions these days, but if we don't use them as intended, then there isn't much point in pretending to democratic rule, the way I see it.

[Mister Nightowl]

16. Mary Mayhew

Am I the only one who thinks she was going for "The Palin Look" during that presser?

[polichick]

18. The nurse is on tv now, making a statement.

[WinkyDink]

29. How is she so cocksure she won't develop symptoms? (Cf., Spencer, Dr.)

[adigal]

31. She fell in love with the spotlight, and wants it to continue

I can't think of any other reason a supposedly intelligent person would fight a 21 day quarantine at home. She's in love with her press.

I am really disliking this selfish and entitled woman.

[etherealtruth]

43. ...or she fell in love with her civil liberties

Most folk would be angry at what amounts to house arrest without cause.

[adirondacker]

32. In case anyone hasn't noticed, the North East is about as fucked up as the South.

Common Core should finish leveling the playing field.

[KingCharlemagne]

45. Please don't give its marketers any more ideas. "Common Core: The Great

Leveller".

Pardon me while I

[adirondacker]

47. C'mon, what else are they gonna sell us to repair the inequality issues of today.

[B2G]

37. I'll bet the 400+ HCWs who got it

didn't think they would either.

[morningfog]

49. And that is totally irrelevant to whether an asymptomatic

person is free to move about.

[TorchTheWitch]

68. so what about all those other asymptomatic people put in quarantine?

Like Duncan's family, the EMT's who picked him up, whoever else was in that group of 10 quarantined people that had exposure to him as well as the NBC crew that had some sort of exposure to the infected cameraman?

None of them were symptomatic yet all were quarantined some under mandatory quarantine for breaking their voluntary quarantine, and I don't recall you complaining they shouldn't have been in quarantine at all because none of them had any symptoms and should be free to walk about. The CDC decided that because they had contact either direct or indirect with infected persons with symptoms no matter how mild they needed to be in quarantine.

The CDC also decided that all the workers who cared for Mr. Duncan or handled his infectious waste only needed to self-monitor, but when two of those workers became infected they were spanked for not putting them in quarantine so they did, and also made anyone that came into contact with infected workers also have to self-monitor. I don't recall your ever saying that none of these people should have had to be in quarantine at all even though two of them became infected causing yet more people to have to self-monitor.

The truth is that the science of Ebola is conflicting. Though we know a lot about it we don't know everything about it, and science admits this. Though science believed that no one who was infected before they showed symptoms could infect anyone else there is now other science that isn't so sure and believes that it may be possible for infected yet asymptomatic people to be contagious. There is yet no concrete absolute 100% scientific knowledge of Ebola, so how can the public and public health administrators rely entirely on the science of Ebola?

It's also in the public interest that public health administrators act in such a way as to reassure the public and not to cause real harm to anyone in the public through inefficient action. Allowing high risk individuals to go about normally in public until they become symptomatic causes real harm and possible real risk to others who came into even indirect contact with an early symptomatic person or even into contact with a later stage symptomatic person who was unable to get out of the public when their symptoms became more contagious who then have to be tracked and monitored causing real fear and real possible consequences.

Dr. Spencer was symptomatic at the bowling alley and because of that others at the bowling alley had to be tracked and self-monitor. Suppose one of those people was a single mother with a low wage job and is barely holding it together. Her boss finds out that she's being monitored for possible exposure to Ebola and for the sake of the company and the co-workers fires her. We already do know that people exposed in any way to Ebola that have to be quarantined or self-monitor have been shunned and caused real harm, and those people in the lives of those quarantined or self-monitoring people are also caused real harm.

For example, recently I posted some material from 60 Minutes that last Sunday did a show talking with four of the nurses that cared for Mr. Duncan some of whom also cared for Ms. Pham when she became ill. Not only did they themselves become ostracized but people in their lives also did...

Public health officials have to make decisions based on medical science but ALSO to prevent real consequences to members of the public whether that's based on medical science or not. Certainly the ostracizing of workers and also those people in their lives being also ostracized is not based on science or even in any otherwise logical way, but it DOES happen and WILL happen regardless.

The bowling alley and restaurant that Dr. Spencer was in while he had early symptoms had to close and disinfect their businesses only to reassure the public and have lost business because of the fear of the public. Children of those people that had contact with someone who had Ebola and even those people who didn't but had contact with those who did have been ostracized, removed from school, etc.

These are real life consequences not based on science but in fear, and it is in the public health administration's interest to protect these people from these real life consequences as well. They have to act not just on the medical science but in the interest of the public in other ways whether any consequences to the general public or certain members of the general public are based on fear or medical science.

While I don't think a full quarantine for care workers coming back to the US from West Africa is necessary I don't think self-monitoring while going about in public is appropriate either not so much that they might spread Ebola but to avoid any real life consequences of any they come into contact with should they become ill.

As I said in a couple of other threads I think a sort of quasi-quarantine that's more like an R&R such as the military does is not only more appropriate but that these workers should have a period of R&R after the work they've been doing whether they think they need one or not. The period need not be for a full 21 days since as far as we know infected people normally begin to show symptoms during the 8-10 window from the time of last exposure. A week and a half or two weeks of R&R that's also a quasi-quarantine with self-monitoring after that until the 21 day period is over seems more logical.

And of course the R&R period should be paid for. No one who has been doing this work in West Africa should be expected to return and immediately return to their regular jobs because of financial need. The military has long recognized that personnel need a period of R&R after a tour of duty or periodically during a long tour of duty. I believe an R&R period is just as necessary for these returning care workers and well-deserved. They should be able to decide if they want to do the R&R/quasi-quarantine at their homes or if they don't want to risk possible exposure to family or pets in the homes or even just the fear of possible exposure or the possible quarantining of pets then there should be a facility appointed for them that they can go to.

We have plenty of unused military bases where these workers can stay where they wouldn't be all alone and have things to do and be able to enjoy the open air. They also should have advocates whether at home or in a facility to help them transition back to their regular life who would also recognize any possible emotional/mental/physical issues from what they experienced in West Africa. Frankly, were it me I'd likely need a good month of R&R and a shrink... I don't know how these people cope with what they've done and seen while doing this noble work nor be expected to entirely cope with immediately having to transition back into their regular life in the US. They should be getting a paid period of R&R anyway, and why not combine that with a quasi-quarantine.

[morningfog]

69. I did criticize the prior quarantines.

Especially Duncan's family. The science is clear, there is no risk without symptoms. And with mild symptoms even the risk is next to zero.

Everything else is self-created overreaction. Cruise ships drifting, wedding stores closing, planes notifying passengers, boing alleys disinfecting, all of it, ignorant overreaction that is costly and only foments fear.

Another problem is when quarantines are out in place without a scientific basis, te public is misled and misinformed. The shunning is perpetuated and the public is confused.

Public health policy should be solely based on science and not on perception or politics. The return on the latter is fear and misunderstanding.

The better approach would be to educate the public and have out policies compor with that education.

[eShirl]

41. no shock; Chris Christie has been up here constantly trying to save LePage's governorship

giving him bad advice too, no doubt

[KingCharlemagne]

46. Isn't that some creepy shit? Great: Let's politicize public health

responses to contagious diseases. And I thought Republicans favored "less" government. Silly me.

[LostInAnomie]

50. Why would they lose?

Quarantines have always been legal. Public health officials have the right to quarantine anyone they have a reasonable suspicion of being exposed to an infectious disease. Kaci Hickox qualifies.

[morningfog]

51. There is no reasonableness to this.

[LostInAnomie]

52. Why not?

There is no doubt that she has been exposed to Ebola. That qualifies her for quarantine.

[morningfog]

53. She is asymptomatic. Ergo, ahe is not infectious or a risk.

Quite simple really.

[LostInAnomie]

54. That isn't the standard for quarantine.

The standard is a reasonable suspicion that the person has been exposed. It would be pointless if health officials had to wait around until someone is infectious. Since Ebola has a 21 day incubation period it isn't unreasonable to make her wait 21 days.

[morningfog]

56. That is not accurate.

It isn't as if a switch is suddenly switched and one becomes infectious. It is a build up of the virus that makes it detectable and produces the early symptoms. Thereafter, untreated, it becomes contagious.

There is fundamentally no basis to restrict an asymptomatic person's mobility and liberty. Not only not a reasonable basis, but no basis whatsoever.

[LostInAnomie]

59. That is accurate.

Public health officials absolutely have the right to quarantine Kaci Hickox. Her currently being asymptomatic means nothing because the incubation period isn't up yet. The disease may be only contagious when symptoms are present, but that doesn't mean health officials have to wait until then. Quarantine is a reasonable precaution to limit the risk of mishaps.

[Logical]

70. Links to your case law please! Nt

[LostInAnomie]

73. Here you go.

Siegel v. Shinnick

[The] judgment required is that of a public health officer and not of a lawyer used to insist on positive evidence to support action; their task is to measure risk to the public and to seek for what can reassure and, not finding it, to proceed reasonably to make the public health secure. They deal in a terrible context and the consequences of mistaken indulgence can be irretrievably tragic. To supercede their judgment there must be a reliable showing of error.
http://law.justia.com/cases/federal/district-courts/FSupp/219/789/1438260/

Jacobson v. Massachusetts

Harlan ruled that personal liberties could be suspended given external circumstances. During an outbreak, for example, the state can encroach on those liberties when "the safety of the general public may demand."[1] He compared the smallpox outbreak to the Civil War (in which three out of nine Justices at the term served) by saying that a community has the right to protect itself both from disease and from military invasion.
http://en.wikipedia.org/wiki/Jacobson_v._Massachusetts
https://supreme.justia.com/cases/federal/us/197/11/case.html

State Authority to Quarantine or Isolate

In certain public health emergency situations, states have the authority to quarantine and isolate individuals in order to prevent the transmission of communicable and dangerous diseases and infections5. The Public Health Service (PHS) Act6, limited by Executive Order 13,2957, authorizes the Secretary of the Department of Health and Human Services (HHS) to declare a public health emergency and take appropriate responsive action to "prevent the introduction, transmission, or spread of communicable diseases8." In practice, however, states and local jurisdictions assume primary responsibility for instituting public health protective measures under their Tenth Amendment "police power9." This authority has been reaffirmed by the Supreme Court of the United States10 and further bolstered by the doctrine of parens patriae11 and state constitutions12. The authority, however, is not limitless; it is tempered by individual rights and civil liberties, guaranteed by the Due Process Clause of the Constitution.
http://www.americanbar.org/publications/law_practice_today_home/law_practice_today_archive/april11/protecting_civil_liberties_during_quarantine_and_isolation_in_public_health_emergencies.html

[morningfog]

76. All of those turn on the reasonableness as supported

by science. Yes, the state has the authority to quarantine when there is an actual risk.

Here, there is no risk if infection from an asymptomatic person. That is the critical difference that Christie's supporters ignore. And that is why the state will lose.

[boston bean]

77. Quarantine is for those who have been exposed.

Not whether they have it or not at this very given moment, taking into consideration incubation periods.

Quarantine is for the possibility one may come down with it given their exposure to the disease.

[peace13]

82. It would be good to go to a nursing home or assisted living ....

... Near you. Interview some of the folks in their late eighties and nineties. They will explain what the word quarantine meant in the 'olden days'. My 94 year old uncle had some interesting stories.

[Calista241]

85. Ebola is specifically mentioned as a disease that may require quarantine.

[LostInAnomie]

94. No, all of those turn on the reasonableness of belief of exposure.

There is no doubt that she has been exposed.

Being asymptomatic has nothing to do with anything. A quarantine is put in place to keep exposed people away from the public until it can be determined if they have the disease or not. Since her incubation period is not up, we don't know if she has it or not. Waiting until she is symptomatic would completely defeat the purpose.

[morningfog]

97. You don't understand the science or the law.

[LostInAnomie]

99. You don't understand what words actually mean.

[morningfog]

106. I told you she'd win. I was right.

http://www.bloomberg.com/news/2014-10-31/nurse-hickox-ordered-to-follow-ebola-quarantine-rules-ap-says.html

Today’s order from Maine District Court Chief Judge Charles C. LaVerdiere removes prohibitions on her being in public places or within 3 feet (0.9 meters) of other people. The state hasn’t proved that further curbing Hickox’s movements is necessary to protect others from the dangers of infection, the judge said.

“The court is fully aware that people are acting out of fear and that this fear is not entirely rational,” the judge said.

[peace13]

83. Big surprise!

I knew before reading that there would be some reason to reject your offering!

[LostInAnomie]

93. I figured it would be rejected.

I'm not sure I would call it a "reason" though.

[morningfog]

96. Allow me to clarify for your understanding:

Where the aircraft is not infected, isolation may be imposed if the passenger is a "suspect" (42 C.F.R. § 71.88; W H O Reg. No. 2, Art. 84, sd. 2). A "suspect" is one who is considered by the health authority (medical officer in charge) as having been exposed to infection by a quarantineable disease and to be capable of spreading that disease (42 C.F.R. § 71.1(bb); W H O Reg. No. 2, Art. 1). While isolation is not to be substituted for surveillance unless the health authority considers the risk of transmission of the infection by the suspect to be exceptionally serious (42 C.F.R. § 71.70, W H O Reg. No. 2, Art. 39 sd. 2), the judgment required is that of a public health officer and not of a lawyer used to insist on positive evidence to support action; their task is to measure risk to the public and to seek for what can reassure and, not finding it, to proceed reasonably to make the public health secure.

United States v. Shinnick

Jacobson is a 1905 case addressing whether vaccinations can be required, so not on point.

And from your last link:

states are required to protect civil liberties during public health emergencies16. Quarantine and isolation orders must be conducted in accordance with substantive and procedural due process, and any restrictions of civil liberties should be legal and as minimally restrictive as reasonably possible17. To this end, states should ensure that the following five threshold requirements are met: 1. the individual must pose an actual threat to the public; 2. the intervention must be reasonable and effective; 3. it must be conducted in a manner that comports with equal protection and due process; 4. individuals must be provided with safe and comfortable conditions; and 5. reasonable compensation for loss of income must be ensured18.

Here, the individual poses zero threat, as she is asymptomatic. Second, the intervention is not reasonable, as it is not supported by the science and not effective because it does not treat all equally. Third, it does not comport with equal protection. Others returning from the same nations, with possibly the same exposure are not forced to quarantine. And others treated Ebola patients here are not subject tot quarantine.

If you have anything else to offer, I'll. read it. But, I am telling you, she will win this.

[LostInAnomie]

104. Jesus fucking Christ.

Jacobson applies because it sets the precedent that concern for public health trumps individual liberty. Anyone with a basic understanding of the law and precedent can understand that.

"While isolation is not to be substituted for surveillance unless the health authority considers the risk of transmission of the infection by the suspect to be exceptionally serious "

A public health authority considers the risk serious, so she is being legally quarantined.

Maybe you should actually look at that last link to see what all those things you highlighted actually mean (instead of your untrained interpretation). Tell you what, I'll do it for you:

"1. the individual must pose an actual threat to the public;"

First, the individual must have actually been exposed to an infectious agent (for quarantine) or infected with the agent (for isolation)19, and be in the period of communicability. There is no compelling state interest in quarantining or isolating an individual that does not actually pose a public health risk20. In a situation where the individual does not pose a public health risk, the individual may use the writ of habeas corpus to challenge the legality of her or his detention, but the writ will not be available if a showing of legal cause for the detention can be made21.

She can try to get a writ of Habeas Corpus, but until then, the quarantine is legal.

"2. the intervention must be reasonable and effective;"

Second, the intervention must be "reasonable and effective22." Public health officials must consider the gravity of the public health risk, the mode of transmission, the potential outcomes of possible containment methods, and the least restrictive means of containment. For example, a public health intervention that involves quarantining a large number of individuals suspected of being infected with influenza together could be considered overly intrusive and potentially hazardous. A mass quarantine ignores the less restrictive option of requesting that citizens voluntarily isolate themselves in their own homes, and infringes upon their autonomy and liberty interests. Additionally, quarantining individuals together may increase the virulence of a disease because of the potential for and ease of influenza transmission via aerosol droplets spread during conversations, coughing, or sneezing23. Therefore, mass quarantining for influenza might be less effective than other containment measures and could potentially increase harm. When either mass quarantine or less restrictive means, such as requiring individuals to isolate themselves at home, are utilized, the state's implementation must not be arbitrary or capricious in order to be considered reasonable24.

She's being quarantined in her home, isn't she?

"3. it must be conducted in a manner that comports with equal protection and due process;"

Third, the quarantine or isolation should be imposed in a manner that preserves the individuals' Constitutional rights to equal protection and due process25. To comply with equal protection, the intervention must be non-discriminatory26. For example, confining only Russian immigrants during a tuberculosis epidemic would be considered arbitrary because, on its face, it has little applicability to transmission avenues, and discriminatory due to the focus on nationality or alien status27.

For the state to comply with due process, quarantined or isolated individuals should be provided with adequate notice, the right to counsel, a hearing, and an appeal28. Additionally, the invasive nature of isolation or quarantine, and the potentially stigmatizing consequences, require heightened procedural protections. To this end, individuals should be provided with a full written explanation of why and how they are being subject to isolation or quarantine, including duration, location, and method they may employ in contesting the order29. In addition to a written directive, the individual should be allowed to speak with a health official, either in person or by phone, to receive an explanation of the procedures and how said procedures are the "least restrictive means," given the prognosis of the suspected disease. Not only is such notice congruent with due process, but this form of transparency increases the government's accountability and respect for the autonomy and liberty interests of the citizens the state is obligated to protect, thus enhancing public trust30

All of those protections are being observed.


"4. individuals must be provided with safe and comfortable conditions;"

Fourth, individuals subject to quarantine or isolation should be provided safe and comfortable conditions, including adequate food, shelter, clothing, and medical care31. When possible, the individual should be provided with the choice to isolate or quarantine him or herself within the comfort of his or her own home. When this is impractical, as it may be when the individual needs to receive medical treatment, the facility where the individual must stay should be made as comfortable and un-intrusive as possible.

It's her own home.

"5. reasonable compensation for loss of income must be ensured."

Finally, an individual subject to quarantine or isolation should be provided reasonable compensation for loss of income due to her or his inability to go to work. Quarantine and isolation orders often require individuals to stay away from work to avoid infecting others. This can be problematic, especially when the individual's occupation does not allow them to work from home, or their employer does not provide paid sick leave. Thus, employee concern regarding potential job loss or reduction in pay may result in public resistance to quarantine or isolation orders32. In addition to lost wages, a stigma may attach to individuals who are quarantined or isolated if their employer or colleagues become aware of the reason for their absence from work. In some circumstances, though unlikely to succeed33, the state's restriction on an employee's ability to work may provide legal cause for damages due to interference with the employee's freedom to contract34.

She is going to be compensated.

[morningfog]

105. Time will tell. She will win.

[morningfog]

118. And I was right.

Not so smarmy now?

[adigal]

60. The comments on the NY Times story, hardly a bastion of conservatives

As overwhelmingly FOR quarantine. About 90%. That's because NY Times readers are intelligent.

[morningfog]

63. Anonymous comments on news sites are

a marker of little more than the temperature of trolls.

[adigal]

74. Denial, denial, denial. 80% of Americans agree with the quarantine

You are throwing out a whole lot of Democrats right now, too.

[morningfog]

75. We have our own share if ignorant people.

Public health policy should based on science, not poorly informed public opinion.

[alarimer]

78. They are ignorant morons, like nearly everyone in this thread

What is happening to her is a violation of her civil liberties AND a violation of scientific evidence.

Pant-wetting ignorant hayseeds; that's what this country has become.

[peace13]

86. Would love to hear your response....

..if you became exposed by a person who did not comply with a voluntary quarantine. Even better, if you became infected how would you handle your losses? It is pretty easy to be the decider when one appears to have no risk.

Quarantine has been used in this country since the beginning of time. We have become such a selfish, self centered people that we react like children to a slight inconvenience. The fact is that the exact science isn't known with this virus. The fear of mutation makes it a moving target.

[Demit]

87. Quarantine has been used in this country since the beginning of time.

I didn't know we were that old.

[peace13]

101. I said in this country not on this land.

The country has a birth date, hence the beginning of it's time. But don't distract from the issue that in earlier times people knew that isolation was a necessity at times.

[customerserviceguy]

61. My prediction

She loses in court. I can't imagine too many judges willing to take on the responsibility of others possibly getting infected. It's a much easier path to simply uphold the executive branch in this case. The worst that happens if you're wrong is that someone is off the streets for a couple of weeks, the worst that happens if you void this quarantine is that someone else gets sick with a really nasty illness.

I doubt that there is a lot of precedence for overturning quarantine orders.

[morningfog]

62. Where's the possibility of others getting infected?

[customerserviceguy]

64. If, like Dr. Spencer

she has the virus, but is asymptomatic so far, there is indeed a possibility. I just can't see a judge weighing that against two extra weeks of house confinement, and saying that she can go bowling.

[morningfog]

65. And that is where you are wrong.

Asymptomatic, even if infected = no risk to anyone else.

Even going to the next step, if she registers a fever, like Spencer and then goes in to isolation = no risk to anyone else.

You fears are unfounded. The state's actions are ungrounded and illegal.

[customerserviceguy]

66. They're not my fears

I do describe them as the things that a judge would weigh when considering a case.

Two weeks of staying at home in Maine, after months in West Africa, doesn't seem too bad in comparison.

Dwell on the 'settled' science all you want. We're dealing with emotion here, and most of the American public, including judges, are not Vulcans.

[morningfog]

67. She'll win this. I'd put money on it.

[leftynyc]

79. You will lose that money

Look at post #73 to see why. There is already case law as a precedent for quarantines. You, on the other other, have zero case law backing up your argument. I don't know why people seem to think merely being right on the facts means anything in this case. Legally public health trumps individual liberties.

[morningfog]

107. Wish there had been real money on it:

Today’s order from Maine District Court Chief Judge Charles C. LaVerdiere removes prohibitions on her being in public places or within 3 feet (0.9 meters) of other people. The state hasn’t proved that further curbing Hickox’s movements is necessary to protect others from the dangers of infection, the judge said.

“The court is fully aware that people are acting out of fear and that this fear is not entirely rational,” the judge said.

http://www.bloomberg.com/news/2014-10-31/nurse-hickox-ordered-to-follow-ebola-quarantine-rules-ap-says.html

[leftynyc]

108. What that judge did has NOTHING

to do with what we were discussing. We were discussing her suing the state (or the governor directly) for damages for loss of civil liberties.

[morningfog]

109. LOLOLLOLL!!!!

[leftynyc]

113. So glad you find

the truth funny. If you think those two things are the same, you're not too up on the law.

[morningfog]

114. You don't know what you are talking about.

The thread is about state action and the state seeking a court order. I said the state would lose, they did. I was right.

The sub-thread you referred to was about the exact same topic. The cases cited were about the authority of state action.

You have egg on your face, but you can't change the facts. What I find funny is your fantasy conversation that went on. BTW, she would win if she chooses to sue. But that is not what this thread or my "bet" was about. You were wrong. Deal with it.

[onenote]

111. where exactly in this thread did you discuss her suing the state for damages?

I've looked but I don't see it. In fact, the premise of the thread was that the state would sue her to keep her quarantined and, according the OP (correcly as it turns out) she will argue against the state and win.

[morningfog]

112. It wasn't.

You read it all correctly. The thread was about state action, the nurse disagreeing and the state seeking an order from the court. I said the state would lose, they did. I don't know what the poster is talking about, to be honest.

[NutmegYankee]

115. No. You just lost.

Having read the entire sub thread in context, you stated she'd lose fighting the quarantine.

[riversedge]

81. Here is a short resume of her education/prof. work experience:

http://www.uta.edu/unbranded/alumni/kaci-hickox.php


Healing Touch

Alumna Kaci Hickox takes a reasoned approach to everything. She’s enthusiastic about nursing, but her career choices follow a logical order.

“I always felt a strong desire to work overseas with vulnerable populations, and nursing seemed to be a perfect avenue,” she says. “On top of that, I knew there was—and still is—a nursing shortage and that I would have job security.”

It just made sense to pursue a two-year postgraduate fellowship in applied epidemiology with the Centers for Disease Control and Prevention in Las Vegas.

Think of the CDCP’s Epidemic Intelligence Service as the CIA of public health. EIS teams respond to crises such as the West Nile virus in the 1990s, the anthrax terrorist attacks after 9-11, and the pandemic H1N1 influenza outbreak. Hickox ’02 works with the country’s top epidemiologists to analyze and improve health and disease surveillance.....


- See more at: http://www.uta.edu/unbranded/alumni/kaci-hickox.php#sthash.zZZ7FLpv.dpuf

[HockeyMom]

84. The clock is ticking away

When did she arrive in New Jersey? Tick. How long was she in the hospital in NJ? Tick. How long has she been in Maine? Tick. How long will the courts take to rule on this? Tick, Tick. So if she loses in the courts, and it has been a MONTH since she left Africa, will she still have to have to be quarantined for all 21 days? Illogical.

Hello? This sounds like retribution and not any safety issue which would be LONG GONE after all that time. Punish her is what it sounds like to me.

[Demit]

88. I thought that from the moment I heard they put her in paper scrubs.

Punishment. There was absolutely no need to do the draconian things they did in New Jersey. Take away her clothes? It was stupid theater & I wouldn't be surprised to find out that came directly from the big bully himself. It was sadistic, and I'm sure it's more than a little of what's motivating Ms Hickox. What they did to her they could do to anyone.

[chrisa]

92. That sounds dumb enough for the state to do it.

"It's no longer possible that you have ebola, but rules are rules, so we need to quarantine you for 21 days anyways for no reason!"

[chrisa]

90. She should be quarantined just to make people feel better.

While we're at it, let's quarantine absolutely everyone coming out of West Africa - especially the volunteers. We should also burn all of their belongings, as those may be infected, and quarantine their families just to give people peace of mind.

The volunteers will be literally begging to go to help in Africa after that!

[NM_Birder]

91. Same bullshit panic spreading that occurred about Hantavirus here in NM

Rub some old deer mouse shit in your face, and you only stand a 98% chance of survival ....IF.....you are infected.

[seabeyond]

102. another gov whimpers in defeat. one woman, knocking them all on their ass. yeehah. nt

[malaise]

110. You were correct

Sweet

[morningfog]

116. This was an easy case. I was really amazed that

Christie, lePage and others had tried to stick to it.

[bluedigger]

117. Even Janet Mills, the DA, was against it.

But it's good they argued it out at least, I guess.