APHA2006Essential Communication

Slide1: 

Essential Communication in the Context of Public Health Emergency Detection and Response Tuesday Nov. 7, 2006 American Public Health Association Annual Meeting Patricia M. Sweeney, JD, MPH, RN

Slide2: 

Patricia M. Sweeney, JD, MPH, RN University of Pittsburgh Graduate School of Public Health psweeney@pitt.edu Michael P. Allswede, DO Conemaugh Health System mallswede@conemaugh.net

Background: 

Background

Study purpose: 

Study purpose To discern if current legal infrastructure permits communication essential to early detection of intentional infectious disease outbreaks

Methodology: 

Methodology Literature search Domestic incidents of infectious disease outbreaks Past 20 years Ample documentation

Methodology: 

Methodology U.S. FORENSIC EPIDEMIOLOGY CASE ANALYSES West Nile Virus (New York, NY), August-October 1999 Inhalation and cutaneous anthrax (NY, NJ, FL, Washington, DC), September-December 2001 Inhalation anthrax (Oxford, CT), November 2001 Hepatitis A (Pittsburgh, PA), October-November 2003 Bubonic plague (New York, NY), November 2002 Anthrax hoax (Washington, DC), April 1997 Brucellosis (NH and Boston, MA), March-April 1999 Monkeypox (Milwaukee, WI), May-June 2003 Hantavirus (NM and Four Corners), May-September 1993 Severe Acute Respiratory Syndrome (SARS),(San Jose, CA), April 2003 Plague samples (Lubbock, TX), January 2003 Kombucha tea poisoning (IA), April-May 1995 Salmonella typhimurium outbreak (The Dalles, OR), September 1984

Methodology: 

Analyzed open source documents Developed chronologic case studies denoting every documented communication Applied current legal standards to facts Analyzed laws, regulations and legal principles underlying communication Methodology

Findings: 

Findings Clinical Medicine Public Health Open communication

Findings: 

Findings Clinical Medicine Law Enforcement Constrained communication

Findings: 

Findings Public Health Law Enforcement Constrained communication

Communication between Clinical Medicine Public Health: 

Communication between Clinical Medicine Public Health Supported by State Disease Prevention and Control Statutes Child abuse reporting laws Mandated reporting of specified injuries Legal duty to warn third persons

Communication between Clinical Medicine Public Health: 

Communication between Clinical Medicine Public Health Limited by Variability in state disease reporting statutes Mandated reporters Time requirements Diagnosis certainty Privacy concerns Confidential medical records HIPAA protected health information

Communication between Clinical Medicine Public Health  Law Enforcement: 

Communication between Clinical Medicine Public Health Law Enforcement Supported by State Public Health powers Limited by Disclosure limited to purpose of law Chilling affect of criminalization of public health disclosures

Communication between Clinical Medicine Law Enforcement: 

Communication between Clinical Medicine Law Enforcement Supported by HIPAA Limited by HIPAA Physician – Patient privilege Liability for unauthorized disclosure

Communication between law enforcement public health: 

Communication between law enforcement public health Limited by Compromising investigation Compromising classified sources Compromising ability to prosecute

Recommendations: 

Recommendations Revise disease reporting statutes include suspicion of illness specified indicators of potential BT HIPAA “carve out” for indicators of BT/ intentional outbreak Create new mechanisms for collection and analysis of threat intelligence Permit progressively open communication based upon threat assessment

Conclusion: 

Conclusion A formal mechanism providing a systematic, transparent, reviewable process for information sharing between clinical medicine, public health, and law enforcement is needed to permit the early detection of an intentional infectious disease outbreak.

Slide19: 

Patricia M. Sweeney, JD, MPH, RN University of Pittsburgh Graduate School of Public Health psweeney@pitt.edu Michael P. Allswede, DO Conemaugh Health System mallswede@conemaugh.net