Section 144-258-10 - EXTREME PUBLIC HEALTH EMERGENCY: REPORTING AND CONTROL MEASURESA.ApplicabilityProvisions 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 RequirementsIn 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 MeasuresIn 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; ande. 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 Persons1. 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; orb. 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 PropertyTo 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.
10-144 C.M.R. ch. 258, § 10