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Social Distancing Law Project Michigan Department of Community Health Assessment of Legal Authorities Introduction This report provides an assessment of Michigan抯 legal readiness to address pandemic influenza. This assessment includes both legal authority for pharmaceutical and non-pharmaceutical (social distancing) measures. As set out in the ob体育抯 Interim Pre-pandemic Planning Guidance, at the beginning of an influenza pandemic, the most effective mitigation tool (i.e., a well-matched pandemic strain vaccine) will probably not be available. Therefore, Michigan must be prepared to face the first wave of the pandemic without vaccine and, possibly, without sufficient quantities of influenza antiviral medications. Instead, Michigan must rely on an early, targeted, layered application of multiple, partially effective, non-pharmaceutical measures. These include restrictions on the movement of people and 搒ocial distancing measures� to reduce contact between individuals in the community, schools, and workplace. This report focuses on the ability of Michigan to implement social distancing measures to prevent and control the spread of pandemic influenza, both when an emergency has been declared and in the absence of a declared emergency. Communicable disease surveillance, investigation, or outbreak control may involve the following potential public health procedures or social distancing measures, based upon the current Michigan Department of Community Health All Hazards Response Plan and Pandemic Influenza Plan: Travel alerts, warnings, or bans Communicable disease surveillance at borders Border closures Individual or group isolation Individual or group quarantine Altered work schedules or environmental controls to be enacted in workplaces Cancellation of public gatherings Identification of buildings for community isolation or quarantine Monitoring of isolated or quarantined individuals or groups In its Pandemic Influenza Plan, MDCH addresses social distancing and other measures to be implemented, as appropriate, for each WHO phase / federal government response stage of a pandemic. MDCH抯 current plan (Draft 3.1, May 2007) is posted on the Internet at  HYPERLINK "http://www.michigan.gov/documents/mdch/MDCH_Pandemic_Influenza_v_3.1_final_draft_060107_2__198392_7.pdf"
http://www.michigan.gov/documents/mdch/MDCH_Pandemic_Influenza_v_3.1_final_draft_060107_2__198392_7.pdf. Social distancing interventions can and should be undertaken voluntarily. However, this report covers establishment and enforcement of social distancing means by state and local authorities if necessary to protect public health. This report also covers inter-jurisdictional cooperation and mass prophylaxis readiness. Project Team for Michigan抯Social Distancing Law Project Michigan Department of Community Health: Denise Chrysler, J.D., Project Lead, Director, Office of Legal Affairs. Deborah Garcia-Luna, J.D., Project Co-Lead, Legal Analyst, Office of Legal Affairs. Katherine Allen-Bridson, RN, BSN, CIC, Border Health Project Coordinator Peter Coscarelli, Acting Manager, Support Services Unit, Office of Public Health Preparedness Karen Krzanowski, M.A., M.P.H., State and Federal Policy Specialist and Emergency Management Coordinator, Office of Public Health Preparedness Corinne Miller, PhD, Director and State Epidemiologist, Bureau of Epidemiology Mary Grace Stobierski, DVM, MPH, Manager, Infectious Disease Epidemiology Section Eden V. Wells, MD, MPH, Medical Epidemiologist, Bureau of Epidemiology Marie Parker, Executive Secretary, Office of Legal Affairs, in charge of assembling report and logistics Michigan Department of Attorney General: Robert Ianni, J.D., Division Chief, Tobacco and Special Litigation Division; Director, Homeland Security Ronald J. Styka, J.D., Division Chief, Community Health Division Federal Quarantine Station: Gabriel J. Palumbo, MBA, MPH, Officer in Charge, ob体育 Detroit Quarantine Station Assessment of Legal Authorities The following definitions apply to terms used in this report: 揓urisdiction� refers to Michigan, which is one of the 18 jurisdictions selected for review in the study. 揕egal authority� means any provision of law or regulation that carries the force of law. 揚rocedures� means any procedures established by the jurisdiction relating to the legal question being researched, regardless of whether the procedures have the force of law. 揜estrictions on the movement of persons� means any limit or boundary placed on the free at-will physical movement of adult natural persons in the jurisdiction. 揅losure of public places� means an instruction or order that has the effect of prohibiting persons from entering a public place. 揚ublic place� means a fixed space, enclosure, area, or facility that is usually available for entry by the general public without a specific invitation, whether possessed by government or private parties. 揅urfew� means an order or regulation prohibiting persons from being in certain public places at certain times. 揚erson� [unless indicated otherwise] means a natural person, whether or not individually identified. 揚ublic health emergency� means any acute threat, hazard, or danger to the health of the population of the jurisdiction, whether specific or general, whether or not officially declared. 揝uperior jurisdiction� means the federal government in respect to a state, or a state in respect to a locality. 揑nferior jurisdiction� means a state in respect to the federal government, or a locality in respect to a state government. Exclusions: This assessment excludes federal law. This assessment excludes the closure of schools, which will be covered by another project of the ob体育 Public Health Law Program. However, the issue of school closures will likely come up during discussions at the legal consultation meetings in response to the overall fact pattern. The ob体育 Public Health Law Program will make the results of the ob体育 project on school closure available for the Legal Consultation Meeting associated with this project. I. Restrictions on the Movement of Persons A. Legal powers/authorities to restrict movement of persons during a declared public health emergency � What legal powers or authorities exist that could enable, support, authorize, or otherwise provide a legal basis for any restrictions on the movement of persons during a declared public health emergency? List all legal powers, authorities, and procedures (including but not limited to police powers, umbrella powers, general public health powers, or emergency powers or authorities) that could be used to authorize specific movement restrictions. (Examples: state抯 legal powers, authorities, or doctrines for quarantine (see also subsection I-C below), isolation, separation, or other orders for persons to remain in their homes.) The Michigan Emergency Management Act, 1976 PA 390, MCL 30.401 et seq. TA \l 揗CL 30.401 et seq., Michigan Emergency Management Act, 1976 PA 390� \s 揗CL 30.401 et seq.� \c 2 , provides for planning and response to disasters and emergencies within the state. The Emergency Management Act distinguishes between a disaster and emergency as follows: a disaster is defined as 揳n occurrence or threat of widespread or severe damage, injury, or loss of life or property resulting from a natural or man-made cause, including but not limited to, 卹adiological incident, 卐pidemic, air contamination�.� MCL 30.402(e) TA \l 揗CL 30.402(e)� \s 揗CL 30.402(e)� \c 2 . An emergency is defined as 揳ny occasion or instance in which the governor determines state assistance is needed to supplement local efforts and capabilities to save lives, protect property and the public health and safety, or to lessen or avert the threat of a catastrophe in any part of the state.� MCL 30.402(h) TA \l 揗CL 30.402(h)� \s 揗CL 30.402(h)� \c 2 . The governor is required to issue an executive order or proclamation declaring a state of disaster or emergency if she finds a disaster or emergency has occurred or the threat of a disaster or emergency exists. This question includes all provisions of law or procedure that: Regulate the initiation, maintenance, or release from restrictive measures, including, but not limited to: Who can declare or establish such restrictions? In a declared state of emergency the governor 搃s responsible for coping with dangers to this state or the people of this state presented by a disaster or emergency.� MCL 30.403(1) TA \l 揗CL 30.403(1)� \s 揗CL 30.403(1)� \c 2 . Among the express powers, is the authority to 搖tilize the available resources of the state and its political subdivisions, and those of the federal government made available to the state, as are reasonably necessary to cope with the disaster or emergency.� MCL 30.405(1)(b) TA \l 揗CL 30.405(1)(b)� \s 揗CL 30.405(1)(b)� \c 2 . The governor is also authorized to 損rescribe routes, modes, and destinations of transportation in connection with an evacuation,� to 揷ontrol ingress and egress to and from a stricken or threatened area, removal of persons within the area, and occupancy of premises within the area� and to 搒uspend a regulatory statute, order or rule prescribing the procedures for conduct of state business卐xcept for criminal process and procedures.� MCL 30.405(1)(a), (f) TA \l 揗CL 30.405(1)(f)� \s 揗CL 30.405(1)(f)� \c 2 , (g) TA \l 揗CL 30.405(1)(g)� \s 揗CL 30.405(1)(g)� \c 2 . In addition to those powers expressly granted under the Emergency Management Act, the governor may 揹irect all other actions which are necessary and appropriate under the circumstances.� MCL 30.405(1)(j) TA \l 揗CL 30.405(1)(j)� \s 揗CL 30.405(1)(j)� \c 2 . Who can enforce such restrictions? If the declaration is of a public health emergency, the governor may direct the Michigan Department of Community Health (MDCH) to coordinate all matters pertaining to the response of the state to a public health emergency. MCL 30.408. Accordingly, the MDCH director or his or her designee could issue an order for quarantine. In addition, should the governor issue the order, enforcement could be by any law enforcement officer, since a violation of the governor抯 emergency orders is a misdemeanor. MCL 30.405(2) TA \l 揗CL 30.405(2)� \s 揗CL 30.405(2)� \c 2 . What are the legal powers and authorities for group quarantine? Under the Emergency Management Act, the governor has broad power to issue such orders which are 搉ecessary and appropriate under the circumstances.� Thus, if necessary and appropriate, a group quarantine order may be issued. Anyone violating the order would be guilty of a misdemeanor. What are the legal powers and authorities for area quarantine? The governor has broad authority under the Emergency Management Act to eliminate any obstacles to implementation of necessary population control measures in a public health emergency. What are the penalties for violating movement restrictions? A violation of an executive order issued by the governor following the declaration of a disaster or emergency is punishable as a misdemeanor. MCL 30.405(2) TA \s 揗CL 30.405(2)� . In such circumstances, the maximum penalty is 90 days in jail and/or a fine of $500. MCL 750.504 TA \l 揗CL 750.504� \s 揗CL 750.504� \c 2 . Provide any due process measures for a person whose movement is restricted. Because a violation of an order is a criminal offense, all due process measures attendant to a deprivation of liberty attach to an individual who violates an executive order restricting movement. In addition, any individual who can demonstrate the requisite standing could bring a civil action to challenge the propriety of the declaration or the application of the executive order to the petitioner. Relate to how long such measures can last, whether and how they can be renewed, and the authority/process/notice requirements for ending the measures. The Emergency Management Act provides that the governor抯 declaration of an emergency or disaster can last for up to 28 days. After 28 days, any extension would require a joint resolution of both houses of the legislature. MCL 30.403 TA \l 揗CL 30.403� \s 揗CL 30.403� \c 2 . May create liability for ordering the restriction of movement of persons. Any order that results in an illegal arrest or deprivation of civil rights is actionable under state or federal law. As a general rule, civil liability is limited under state law by governmental immunity. Health officials rendering services during a declared emergency are 搉ot liable for an injury sustained by a person by reason of those services, regardless of how or under what circumstances or by what cause those injuries are sustained,� willful acts and omissions excepted. MCL 30.411 TA \l 揗CL 30.411� \s 揗CL 30.411� \c 2 . Would otherwise tend to limit the legal basis of the jurisdiction. None known. B. Sufficiency of powers/authorities � Discuss the sufficiency of the authorities and powers to restrict the movement of persons during a declared emergency, and any potential gaps or uncertainties in those powers and authorities. Potential gaps? The Emergency Management Act is broad and provides sufficient authority for the governor to issue any order necessary to restrict movement of persons during an emergency or disaster. Uncertainties? None known. Legal provisions that could inhibit, limit, or modify the jurisdiction抯 legal basis to restrict the movement of persons? (Examples: state administrative practice acts, specific provisions in law related to movement restrictions.) As discussed under 揇� (page 7) below, the penalty for violating an order of MDCH抯 director is a misdemeanor punishable by six months in jail and/or a fine of $200. Violating the governor抯 order is punishable by 90 days in jail and/or a fine of $500. Michigan抯 legislature might consider increasing the jail term for violating an order of the governor to six months. In Michigan, if the penalty for a misdemeanor is greater than 92 days imprisonment, law enforcement can arrest based on reasonable cause. If the penalty is 92 days or less, then law enforcement must obtain an arrest warrant or have witnessed the violation. MCL 764.15(1)(d) TA \l 揗CL 764.15(1)(d)� \s 揗CL 764.15(1)(d)� \c 2 . C. Legal powers/authorities specifically related to quarantine enforcement � Specifically related to quarantine orders, identify all state and/or local powers and authorities to enable, support, authorize, or otherwise provide a legal basis for enforcement of quarantines during a public health emergency. What are the legal powers and authorities authorizing law enforcement to enforce quarantine orders issued by the jurisdiction? The Emergency Management Act provides criminal penalties for any violation of an emergency executive order. Accordingly, any law enforcement officer may be called upon to enforce the order. In addition the governor may ask the attorney general to seek civil enforcement. State agencies, such as MDCH may be directed to take administrative action to enforce the order. What are the legal powers and authorities prohibiting or inhibiting the use of law enforcement to enforce a quarantine order issued by the jurisdiction? None known. What are the legal powers and authorities authorizing law enforcement to enforce a federal quarantine order? If a violation of the federal order is subject to a criminal penalty, law enforcement officers in the state of Michigan may assist in the enforcement of the order. What are the legal powers and authorities prohibiting or inhibiting the use of law enforcement to enforce a federal quarantine order? The only question will be whether the officer is enforcing a criminal law of the United States. What are the legal powers and authorities prohibiting or inhibiting the use of law enforcement to assist the federal government in executing a federal quarantine order? If a violation of the federal order is subject to a criminal penalty, law enforcement officers in the state of Michigan may assist in the enforcement of the order. In this regard, the Michigan Attorney General has opined that peace officers of the state may enforce violations of federal laws and regulations, at least when a criminal penalty attaches. OAG, 1967-1968, No 4631, p 194 (March 5, 1968) TA \l 揙AG, 1967-1968, No 4631, p 194 (March 5, 1968)� \s 揙AG, 1967-1968, No 4631, p 194 (March 5, 1968)� \c 3 . However, Michigan law provides no authority for law enforcement officers to enforce federal civil quarantine orders. Potentially, if the governor declares a state of emergency or disaster, she can issue an executive order expanding the powers of the various police agencies to assist federal and state agencies in enforcing quarantine and isolation orders (MCL 30.405 TA \l 揗CL 30.405� \s 揗CL 30.405� \c 2 ). Alternatively, this gap might be addressed by developing a process to appoint local and state police federal agents (much as they are sometimes appointed deputy marshals), in which case they would be acting pursuant to their federal appointment and authority. The governor or the MDCH could also accomplish enforcement by issuing quarantine orders that mirror the federal government抯. State and local police could then enforce a violation of the governor抯 or MDCH抯 orders as a criminal act. D. Sufficiency of powers/authorities to enforce quarantine � Discuss the sufficiency of the authorities and powers to enforce quarantine orders and any potential gaps or uncertainties in those powers and authorities. Potential gaps? The most prominent gap is the lack of authority by law enforcement to enforce a quarantine order, short of making an arrest. Law enforcement may benefit by the passage of legislation giving law enforcement specific authority to enforce public health orders for communicable diseases. Public health also needs to explore the options available for law enforcement in the manner of enforcement of public health orders. An individual who is ordered into isolation because he is ill would be taken to a treatment facility, however, the noncompliant subject of a quarantine order is another question. If police officers arrest and incarcerate people violating quarantine or round up and detain people who refuse an order not to congregate they will likely undo the effects the social distancing measures were intended to bring about. Uncertainties? None known. Are there any other legal provisions not previously listed in I-C above that could inhibit, limit, or modify the jurisdiction抯 legal basis to restrict the movement of persons? (Examples: state administrative practice acts, specific provisions in law related to quarantine.) None known. E. Legal powers/authorities to restrict movement of persons in the absence of a declared public health emergency � What legal powers or authorities exist that could enable, support, authorize, or otherwise provide a legal basis for any restrictions on the movement of persons in the absence of a declared public health emergency? List all legal powers, authorities, and procedures that could be used to authorize specific movement restrictions in the absence of an emergency declaration. (Examples: the state抯 legal powers, authorities, or doctrines for quarantine, isolation, separation, or other orders for persons to remain in their homes.) MDCH has broad and flexible powers to protect the public health, welfare and safety of persons within the state. These powers are set out in the Public Health Code, which is to be liberally construed for the protection of the health, safety, and welfare of the people of Michigan. MCL 333.1111(2) TA \l 揗CL 333.1111(2)� \s 揗CL 333.1111(2)� \c 2 . MDCH is required to generally supervise the interests of the health and life of Michigan抯 residents, implement and enforce public health laws, prolong life, and promote public health through organized programs. It is also specifically responsible for preventing and controlling disease; making investigations and inquiries as to the cause of disease, especially of epidemics; and the causes, prevention, and control of environmental health hazards, nuisances, and courses of illness. MDCH may exercise authority to safeguard properly the public health, prevent the spread of diseases and the existence of sources of contamination, and implement and carry out the powers and duties vested by law in the department. MCL 333.2226(d) TA \l 揗CL 333.2226(d)� \s 揗CL 333.2226(d)� \c 2 . Michigan抯 Supreme Court has long recognized the authority of health officers to issue reasonable orders or regulations to control the spread of disease under their general statutory authority to prevent the spread of infection. People v Board of Education of City of Lansing, 224 Mich 388 (1923) TA \l 揚eople v Board of Education of City of Lansing, 224 Mich 388 (1923)� \s 揚eople v Board of Education of City of Lansing, 224 Mich 388 (1923)� \c 1  (local board of health has authority to issue regulation to exclude unvaccinated children from schools, over the objection of the school board, while 17 cases of smallpox still existed in the city), Rock v Carney, 216 Mich 280 (1921) TA \l 揜ock v Carney, 216 Mich 280 (1921)� \s 揜ock v Carney, 216 Mich 280 (1921)� \c 1  (health officer has quarantine power when sufficient reasonable cause exists to believe that a person is afflicted with a venereal disease). In addition to a general grant of authority, the Public Health Code grants the state health director specific power to issue orders to address an emergency, as described in �1� (pages 9-10) below. Most public health activities, including the prevention and control of communicable diseases, are carried out by Michigan抯 45 local health departments. Local health departments, acting through their local health officers, hold the general powers described above. Further, both state and local health departments are granted 損owers necessary or appropriate to perform the duties and exercise the powers given by law � and which are not otherwise prohibited by law.� MCL 333.2221(2)(g) TA \l 揗CL 333.2221(2)(g)� \s 揗CL 333.2221(2)(g)� \c 2 , MCL 333.2433(2)(f) TA \l 揗CL 333.2433(2)(f)� \s 揗CL 333.2433(2)(f)� \c 2 . Local health officers are also authorized to issue emergency orders, warning notices, and bring court actions, concerning residents within their jurisdictions. The organization and powers of local health departments are set out in MCL 333.2401 � 333.2498 TA \l 揗CL 333.2401 � 333.2498� \s 揗CL 333.2401 � 333.2498� \c 2 . This question includes all provisions of law or procedure that: Regulate the initiation, maintenance, or release from restrictive measures, including, but not limited to: Who can declare or establish such restrictions? If the state health director determines that conditions anywhere in the state constitute a menace to the public health, she is authorized to take full charge of the administration of applicable state and local law, rules, regulations, and ordinances. MCL 333.2251(3) TA \l 揗CL 333.2251(3)� \s 揗CL 333.2251(3)� \c 2 . Additionally, the Public Health Code grants the state health director (and local health officers) power to issue the following orders to address an emergency: Imminent Danger Orders. Upon determining that an 搃mminent danger� to the health or lives of individuals exists in this state, the director shall inform the individuals affected by the imminent danger and issue an order. The order shall be delivered to a 損erson� authorized to avoid, correct, or remove the imminent danger or be posted at or near the imminent danger. MCL 333.2251(1) TA \l 揗CL 333.2251(1)� \s 揗CL 333.2251(1)� \c 2 . 揚erson� includes an individual, any type of legal entity, or a governmental entity. MCL 333.2251(4)(b) TA \l 揗CL 333.2251(4)(b)� \s 揗CL 333.2251(4)(b)� \c 2 . 揑mminent danger� is defined as 揳 condition or practice [that] could reasonably be expected to cause death, disease, or serious physical harm immediately or before the imminence of the danger can be eliminated through enforcement proceedings otherwise provided.� MCL 333.2251(4)(a) TA \l 揗CL 333.2251(4)(a)� \s 揗CL 333.2251(4)(a)� \c 2 . In her order, the director shall incorporate her findings and require immediate action necessary to avoid, correct, or remove the imminent danger. The order may specify action to be taken or prohibit the presence of individuals in locations or under conditions where the imminent danger exists, except individuals whose presence is necessary to avoid, correct, or remove the imminent danger Orders to Control an Epidemic. Upon determining that the control of an epidemic is necessary to protect the public health, the director, by emergency order may prohibit the gathering of people for any purpose and may establish procedures to be followed during the epidemic to insure continuation of essential public health services and enforcement of health laws. MCL 333.2253 TA \l 揗CL 333.2253� \s 揗CL 333.2253� \c 2 . 揈pidemic� means 揳ny increase in the number of cases, above the number of expected cases, of any disease, infection, or other condition in a specific time period, area, or demographic segment of the population.� R 325.171(g) TA \l 揜 325.171(g)� \s 揜 325.171(g)� \c 4 . Orders to Abate a Nuisance. The director may issue an order to avoid, correct, or remove, at the owner抯 expense, a building or condition that violates health laws or which the director reasonably believes to be a nuisance, unsanitary condition, or cause of illness. MCL 333.2455 TA \l 揗CL 333.2455� \s 揗CL 333.2455� \c 2 . Finally, the Public Health Code provides for the involuntary detention and treatment of individuals with hazardous communicable disease. MCL TA \l 揗CL 333.2453(2)� \s 揗CL 333.2453(2)� \c 2  333.2453(2). Upon a determination by a representative of MDCH (or the local health department) that an individual is a 揷arrier� and is 揳 health threat to others,� MDCH抯 representative shall issue a warning notice to the individual requiring the individual to cooperate with MDCH or the local health department in efforts to prevent or control transmission of 搒erious communicable diseases or infections.� The warning notice may also require the individual to participate in education, counseling, or treatment programs, and to undergo medical tests to verify the person抯 status as a carrier. A 揷arrier� is 揳n individual who serves as a potential source of infection and who harbors or who the department reasonably believes to harbor a specific infectious agent or a serious communicable disease or infection, whether or not there is present discernible disease.� MCL 333.5201(1)(a) TA \l 揗CL 333.5201(1)(a)� \s 揗CL 333.5201(1)(a)� \c 2 . 揌ealth threat to others� means that the individual 揾as demonstrated an inability or unwillingness to conduct himself or herself in such a manner as to not place others at risk of exposure to a serious communicable disease or infection.� MCL 333.5201(1)(b) TA \l 揗CL 333.5201(1)(b)� \s 揗CL 333.5201(1)(b)� \c 2 . A warning notice: Must be in writing (may be verbal in urgent circumstances, followed by a written notice within 3 days). Must be specific and individual, cannot be issued to a class of persons. Must require the individual to cooperate with the health department in efforts to control spread of disease. May require the individual to participate in education, counseling, or treatment programs, and to undergo medical tests to verify carrier status. Must inform the individual that if the individual fails to comply with the warning notice, the health department shall seek a court order. If the individual fails or refuses to comply with the warning notice, the health department must petition the circuit court (family division) for an order requiring testing, treatment, education, counseling, commitment, isolation, etc., as appropriate. In an emergency, the health department may go straight to court (without first issuing a warning notice). Upon filing of affidavit by the health department, the court may order that individual be taken into custody and transported to an appropriate emergency care or treatment facility for observation, examination, testing diagnosis, treatment, or temporary detention. The court抯 emergency order may be issued ex parte; however, the court must hold a hearing on the temporary detainment order within 72 hours (excluding weekends and holidays). Who can enforce such restrictions? MDCH would need to rely on law enforcement and courts to enforce its orders. Violation of an order of the director is a misdemeanor, punishable by six months in jail or $200, or both. MCL 333.2261 TA \l 揗CL 333.2261� \s 揗CL 333.2261� \c 2 . In Michigan, if the penalty for a misdemeanor is greater than 92 days imprisonment, law enforcement can arrest based on reasonable cause (i.e., without an arrest warrant or witnessing the violation), pursuant to MCL 764.15(1)(d) TA \s 揗CL 764.15(1)(d)� . While violation of the director抯 order is a misdemeanor, there is no parallel provision in the Public Health Code for violation of a local health officer抯 order. State law provides that a violation of a local health regulation is a misdemeanor. Therefore, this gap can be addressed by each local government adopting a regulation requiring persons to comply with a lawful order of the local health officer. Failure to comply with an order of the local health officer would be a violation of the regulation and punishable as a misdemeanor under state law. In some circumstances, a local health department may be able to seek enforcement under a provision of the Public Health Code that states it is a misdemeanor to willfully oppose or obstruct a representative of MDCH, the state or a local health officer, or any other person charged with enforcement of a health law in the performance of that person抯 legal duty to enforce that law. MCL 333.1291 TA \l 揗CL 333.1291� \s 揗CL 333.1291� \c 2 . Finally, MDCH (and local health officers) can go to court to seek enforcement of its orders. MCL 333.2251(2) TA \l 揗CL 333.2251(2)� \s 揗CL 333.2251(2)� \c 2 , MCL 333.2451(2) TA \l 揗CL 333.2451(2)� \s 揗CL 333.2451(2)� \c 2 . The court could punish civilly or criminally via contempt. MDCH (and local health officers) may also maintain injunctive action 搕o restrain, prevent, or correct a violation of a law, rule, or order which the department [local health officer] has the duty to enforce or to restrain, prevent, or correct an activity or condition which the department believes adversely affects the public health.� MCL 333.2255 TA \l 揗CL 333.2255� \s 揗CL 333.2255� \c 2 , MCL 333.2465 TA \l 揗CL 333.2465� \s 揗CL 333.2465� \c 2 . What are the legal powers and authorities for group quarantine? 揋roup quarantine� is not explicitly addressed in the Public Health Code. However, MDCH抯 director and local health officers have the authority to issue an imminent danger order, and require 揼roup quarantine� as action required to avoid, correct, or remove the imminent danger. Alternatively, the director or local health officer could issue an emergency order to control an epidemic and require group quarantine as a procedure to be followed during the epidemic. What are the legal powers and authorities for area quarantine? 揂rea quarantine� is not explicitly addressed in the Public Health Code. However, MDCH抯 director and local health officers have the authority to issue an imminent danger order, and require 揳rea quarantine� as action required to avoid, correct, or remove the imminent danger. Alternatively, the director or local health officer could issue an emergency order to control an epidemic and require area quarantine as a procedure to be followed during the epidemic. What are the penalties for violating movement restrictions? Violation of the order of MDCH抯 director is a misdemeanor, punishable by six months imprisonment, $200 fine, or both. Provide any due process measures for a person whose movement is restricted. Both the U.S. and the Michigan Constitution prohibit depriving a person of liberty without due process of law. Const 1963, Art I, � 17 TA \l 揅onst 1963, Art I, � 17� \s 揅onst 1963, Art I, � 17� \c 7 . Due process is flexible; what process is due depends on the nature of the proceedings, the risks and costs involved, and the private and governmental interests affected. By Lo Oil Co v Dept of Treasury, 267 Mich App 19 (2005) TA \l 揃y Lo Oil Co v Dept of Treasury, 267 Mich App 19 (2005)� \s 揃y Lo Oil Co v Dept of Treasury, 267 Mich App 19 (2005)� \c 1 . There are no statutory provisions, rules, or procedures with regard to the process for review of imminent danger orders or orders to control an epidemic. Fundamental fairness requires that orders directed toward individuals must be served on the individuals and orders directed toward groups or the general public must be sufficiently publicized to provide notice to individuals of required or prohibited conduct. Violation of an order by MDCH抯 director is a criminal offense. Thus, all due process measures attendant to a deprivation of liberty attach to a person who violates an order of the director that restricts movement. In addition, any person who can demonstrate the requisite standing could bring a civil action to challenge the propriety of the director抯 order or the application of the order to the petitioner. The Public Health Code sets out procedures for enforcement of a warning notice issued by MDCH抯 director or a local health officer against a carrier who is a health threat to others. The individual has the right to an evidentiary hearing and the health department must prove the allegations by clear and convincing evidence. Before committing an individual to a facility, the court must consider the recommendation of a commitment panel, and the commitment order must be reviewed periodically. An individual who is the subject of either emergency proceedings or a petition on a warning notice has the right to counsel at all stages of proceedings. An indigent individual is entitled to appointed counsel. The individual also has the right to appeal and review by the Michigan Court of Appeals within 30 days. MCL 333.2453(2) TA \s 揗CL 333.2453(2)� , MCL 333.5201 � 333.5207 TA \l 揗CL 333.5201 � 333.5207� \s 揗CL 333.5201 � 333.5207� \c 2  Relate to how long such measures can last, whether and how they can be renewed, and the authority/process/notice requirements for ending the measures. There is no time limit on any of the state or local health officers� orders; nor is there a renewal requirement. The health officer who issued an emergency order would be responsible for monitoring the conditions that warranted the order, and respond as appropriate by modifying or rescinding the order as conditions change. Notice of any modifications, or rescission, would need to be sufficient to reasonably notify individuals or groups who are subject to the order. May create liability for ordering the restriction of movement of persons. MDCH and its employees and volunteers have governmental immunity from tort damages when engaged in a governmental function, absent 揼ross negligence� that is the proximate cause of the injury or damage. MCL 691.1407. Note: this section does not apply with respect to providing medical care or treatment to a patient with some exceptions. However, if an emergency were declared, the Emergency Management Act, MCL TA \s 揗CL 30.411�  30.411, would provide protection from liability. Additionally, MDCH抯 director, or an employee or representative of MDCH is not personally liable for damages sustained in the performance of departmental functions, except for wanton and willful misconduct. MCL 333.2228 TA \l 揗CL 333.2228� \s 揗CL 333.2228� \c 2 . The same provision applies to local public health. MCL 333.2465(2) TA \l 揗CL 333.2465(2)� \s 揗CL 333.2465(2)� \c 2 . Would otherwise tend to limit the legal basis of the jurisdiction. None known. F. Sufficiency of powers/authorities � Discuss the sufficiency of the authorities and powers to restrict the movement of persons in the absence of a declared emergency, and any potential gaps or uncertainties in those powers and authorities. Potential gaps? Staff from MDCH and local health departments have participated in several activities to evaluate the sufficiency of the authorities and powers to restrict the movement of persons in the absence of a declared emergency. These activities include participation in the Turning Point Collaborative, table top and other facilitated exercises, and a roundtable discussion by a group of public health and legal experts on Michigan law. For the most part, the consensus of both state and local public health is that the Public Health Code provides broad and flexible powers that are sufficient for prompt and effective response to a public health emergency. While it is tempting to seek legislation that authorizes specific measures that might be imposed, there is a risk that public health抯 authority would be narrowed by too much specificity and detail under the principle expressio unius est exclusio alterius (the express mention of one thing implies the exclusion of all others). As discussed above, one gap in enforcing restrictions of movement is the lack of a criminal penalty for violation of an emergency order of a local health officer. Another potential gap is the absence of provisions for due process where orders issued by MDCH or local health officers deprive individuals of liberty. This could be addressed either through legislation or by MDCH promulgating rules consistent with Michigan抯 Administrative Procedures Act. MCL 24.231 et seq. TA \l 揗CL 24.231 et seq.� \s 揗CL 24.231 et seq.� \c 2  However, care is essential in establishing procedures to avoid binding the state and local health departments to a process or procedures beyond legal requirements that unnecessarily restrict their ability to act promptly and effectively to protect the public health. While MDCH has addressed most social distancing measures in its Pandemic Influenza Plan, it has not addressed mass transit usage limits. MDCH needs to review this for inclusion as a potential social distancing measure to reduce spread of disease from close proximity of individuals typical of crowded mass transit. Uncertainties? Under Michigan抯 Constitution, Michigan抯 public universities constitute a 揵ranch� of state government, autonomous within their own spheres of authority. Const 1963, Art VIII, Ё 5, 6 TA \l 揅onst 1963, Art VIII, Ё 5, 6� \s 揅onst 1963, Art VIII, Ё 5, 6� \c 7 , National Pride at Work, Inc v Governor, 274 Mich App 147 (2007) TA \l 揘ational Pride at Work, Inc v Governor, 274 Mich App 147 (2007)� \s 揘ational Pride at Work, Inc v Governor, 274 Mich App 147 (2007)� \c 1 , and cases cited therein. University governing boards might question whether the state health department has authority to issue orders that affect the operation of the university, such as orders to quarantine dorm students or prohibit class attendance. However, universities are not exempt from all regulation. MDCH needs to obtain advice from the Department of Attorney General regarding the parameters of its authority over university campuses, and the authority (if any) of local health departments. MDCH should engage the universities to develop memoranda of understanding and procedures for coordinating an effective response to pandemic influenza or other disease outbreaks. Legal provisions that could inhibit, limit, or modify the jurisdiction抯 legal basis to restrict the movement of persons? (Examples: state administrative practice acts, specific provisions in law related to movement restrictions.) While MDCH is authorized to implement its police and statutory powers, there are limits on the exercise of these powers. These limitations include constitutional rights to substantive and procedural due process and equal protection under the laws. MDCH must act in good faith, and must not abuse its discretion in restricting the movement of individuals. In Rock v Carney, TA \s 揜ock v Carney, 216 Mich 280 (1921)�  supra, the Michigan Supreme Court upheld the authority of public health boards to determine what constitutes a dangerous communicable disease and take measures to prevent the spread. However, the method adopted or exercised to prevent the spread thereof must bear some true relation to the real danger, and be reasonable, having in mind the end to be attained, and must not transgress the security of the person beyond public necessity. 216 Mich 280, 296. In the Rock case, the Supreme Court held that the health officer abused his discretion by refusing home isolation and placard notice for a young woman with venereal disease, and instead removed the woman from her home and committed her to a hospital for twelve weeks. Other limitations on exercising authority to restrict movement of persons: Tribal boundaries, tribal entities. MDCH is in the process of drafting provisions for its pandemic influenza plan that address limitations on the exercise of authority on Indian land or concerning federally recognized tribes. Its All Hazards and Pandemic Influenza Plans currently provide: State-Tribal Borders: Public health emergencies occurring on tribal land are the responsibility of the tribal organization. Some Mutual Aid Agreements (MAAs) have been developed between local or state health or emergency agencies and tribes. In instances where pre-arranged MAAs have not been developed, Local or State Health organizations may provide services on tribal land upon the invitation of the tribe. (Emphasis in original). Foreign Diplomats: In Attachment 18 of its Pandemic Influenza Plan, MDCH addresses its limitations to impose quarantine or other restrictions on foreign diplomats and their families and honorary counsels, and procedures to be followed in the event of a disease outbreak. Attachment 18 is attached to this assessment as Appendix 2. Federal land, including military bases and V.A. hospitals. MDCH needs to research and address limits on its jurisdiction over federal lands. MDCH needs to coordinate with federal authorities to develop procedures and emergency communications protocol in the event of a pandemic influenza or other disease outbreak.  II. Curfew A. Legal powers/authorities for curfew during a declared public health emergency � What legal power, authorities, or procedures exist that that could enable, support, authorize, or otherwise provide a legal basis for curfew during pandemics, when a public health emergency has been declared? What are the powers and authorities to institute curfews? Can local governments institute their own curfews under state and/or local law? The governor is specifically empowered to proclaim a state of emergency and designate the area involved 揫d]uring times of great public crisis, disaster, rioting, catastrophe, or similar public emergency within the state, or reasonable apprehension of immediate danger of a public emergency of that kind, when public safety is imperiled.� After making the proclamation or declaration, the governor may promulgate reasonable orders, rules, and regulations necessary to protect life and property or bring the emergency situation with the affected area under control. The orders, rules, and regulations, may include curfew, as well as other measures. MCL 10.31 TA \l 揗CL 10.31� \s 揗CL 10.31� \c 2 . Additionally, under the Emergency Management Act the governor has broad power to take any action that is necessary and appropriate during a declared emergency or disaster and may issue a curfew order. Local governmental units may declare a local state of emergency and take action to 損rovide for the health and safety of persons and property�.� Notice is required. The Emergency Management Act provides that the order shall be� disseminated promptly by means calculated to bring its contents to the attention of the general public.� MCL  TA \s 揗CL 30.403� 30.403. The order must also be filed with the secretary of state. Who can order curfew, and, if different, who makes the decision to institute curfew? Under the Emergency Management Act, the governor would issue the order. The chief executive official of the county or municipality would issue local orders. MCL 30.410 TA \l 揗CL 30.410� \s 揗CL 30.410� \c 2 . What is the process for mobilizing public health/law enforcement of curfew? There is no process set out in the Emergency Management Act for mobilizing public health/law enforcement of curfew. The director of the State Police is charged with implementing the orders and directives of the governor. MCL 30.407 TA \l 揗CL 30.407� \s 揗CL 30.407� \c 2 . Who can enforce curfew? Again, because violations of the governor抯 emergency orders are misdemeanors, any law enforcement officer may enforce the order. Penalties for violating curfew? Penalties are 90 days imprisonment, or $500, or both. MCL 10.33 TA \l 揗CL 10.33� \s 揗CL 10.33� \c 2 , MCL  TA \s 揗CL 30.405(2)� 30.405(2), MCL TA \s 揗CL 750.504�  750.504. How long can a curfew last? The curfew order could remain in effect for 28 days unless extended by joint resolution of the legislature. How can it be renewed? A curfew order can be renewed only by joint resolution of the legislature. Describe the authority/process/notice requirements for ending a curfew. The governor may rescind the order at any time. This can be done through issuance of an executive order in which case prompt public notice is required. B. Sufficiency of powers/authorities � Discuss the sufficiency of the authorities and powers to institute or maintain curfew during a declared emergency, and any potential gaps or uncertainties in those powers and authorities. Potential gaps? None known. Uncertainties? None known Legal provisions that could inhibit, limit, or modify the jurisdiction抯 legal basis to institute or maintain curfew? (Examples: state administrative practice acts, specific provisions in law related to curfew.) None known. C. Legal powers/authorities for curfew in the absence of declared public health emergency � What legal power, authorities, or procedures exist that that could enable, support, authorize, or otherwise provide a legal basis for curfew during pandemics, in the absence of a declared public health emergency? What are the powers and authorities to institute curfews? Can local governments institute their own curfews under state and/or local law? MDCH抯 Director, or local health officers within their jurisdictions, could order curfew under their broad authority, provided curfew is a reasonable measure to address an imminent health danger or to control an epidemic. MCL 333.2251 TA \l 揗CL 333.2251� \s 揗CL 333.2251� \c 2 ,  TA \s 揗CL 333.2253� 333.2253, 333.2451 TA \l 揗CL 333.2451� \s �333.2451� \c 2 , 333.2453 TA \l 揗CL 333.2453� \s �333.2453� \c 2 . However, a state or local health officer抯 authority does not include issuing orders (such as curfew) as general safety measures to manage disturbances or protect property. Who can order curfew, and, if different, who makes the decision to institute curfew? MDCH抯 director would make the decision to institute curfew, and would issue an order imposing curfew that could cover all or any area of the state. The local health officer would make the decision and issue an order imposing curfew for the local health department抯 jurisdiction. What is the process for implementing curfew? The Public Health Code does not set out a process, and one has not been developed by MDCH. What is the process for mobilizing public health/law enforcement of curfew? The Public Health Code does not set out a process, and one has not been developed by MDCH. Who can enforce curfew? Any law enforcement officer could enforce curfew imposed by an order of MDCH抯 director since it is a misdemeanor to violate an order of MDCH. MCL  TA \s 揗CL 333.2261� 333.2261. There is no parallel provision for violation of a local health officer抯 order, so enforcement would most likely depend on local regulations. Penalties for violating curfew? Violation of an order of MDCH is a misdemeanor punishable by six months in jail, a fine of $200, or both. How long can a curfew last? There is no time limit on any of the state or local health officers� orders. How can it be renewed? There is no renewal requirement. Describe the authority/process/notice requirements for ending a curfew. If the state or a local health officer has the authority to impose curfew, then they have the authority to modify or end curfew. The health officer who issued an emergency order would be responsible for monitoring the conditions that warranted the order, and respond as appropriate by modifying or rescinding the order as conditions change. Notice of any modifications, or rescission, would need to be sufficient to reasonably notify individuals or groups who are subject to the curfew. D. Sufficiency of powers/authorities � Discuss the sufficiency of the authorities and powers to institute or maintain curfew in the absence of a declared emergency, and any potential gaps or uncertainties in those powers and authorities. Potential gaps? No known gaps in powers or authorities. However, MDCH does not address the use of curfew as a public health measure in its All Hazards Response Plan or any of its other plans. MDCH抯 response plans should be reviewed for possible inclusion of curfew. Uncertainties? None known. Legal provisions that could inhibit, limit, or modify the jurisdiction抯 legal basis to institute or maintain curfew? (Examples: state administrative practice acts, specific provisions in law related to curfew.) As discussed in I above, exercise of state and local health authority must be in good faith, reasonable, and consistent with constitutional rights to substantive and procedural due process and guarantees of equal protection. III. Inter-jurisdictional Cooperation and Restricting Movement of Persons A. Legal provisions/procedures for inter-jurisdictional cooperation on restricting the movement of persons during a declared public health emergency � What provisions or procedures under law apply to giving and receiving assistance and otherwise working with other jurisdictions regarding restrictions of movement of persons during a declared public health emergency? Provisions or procedures governing the relationships among superior jurisdictions? Among inferior jurisdictions? The Michigan Emergency Management Act, and plans thereunder, contain provisions requiring or authorizing inter-jurisdictional cooperation among superior jurisdictions and inferior jurisdictions. The Emergency Management Act authorizes the governor to enter into a reciprocal aid agreement or compact with another state, the federal government, or a neighboring state or province of a foreign country, with the following limitations: A reciprocal aid agreement shall be limited to the furnishing or exchange of food, clothing, medicine, and other supplies; engineering services; emergency housing; police services; the services of the national guard when not mobilized for federal service or state defense force as authorized by the Michigan military act, � MCL 32.501 to 32.851 � and subject to federal limitations on the crossing of national boundaries by organized military forces; health, medical, and related services; fire fighting, rescue, transportation, and construction services and equipment; personnel necessary to provide or conduct these services; and other necessary equipment, facilities, and services. A reciprocal aid agreement shall specify terms for the reimbursement of costs and expenses and conditions necessary for activating the agreement. The legislature shall appropriate funds to implement a reciprocal aid agreement. MCL 30.404(3) TA \l 揗CL 30.404(3)� \s 揗CL 30.404(3)� \c 2 . The Emergency Management Act requires the emergency management division of the state police to prepare and maintain a comprehensive emergency management plan that covers mitigation, preparedness, response, and recovery for the state. MCL 30.407a TA \l 揗CL 30.407a� \s 揗CL 30.407a� \c 2 . The Emergency Management Act further requires the director of each department of state government to participate in emergency planning for the state, serve as emergency management coordinator for his or her respective department, and provide an annex to the Michigan emergency management plan providing for the delivery of suitable emergency management activities. MCL 30.408 TA \l 揗CL 30.408� \s 揗CL 30.408� \c 2 . The Michigan emergency management plan describes the roles, responsibilities, and assignments of state departments, and provides the framework for state and local entities to work together under an incident command structure to address various types of emergencies. Under the emergency management plan, MDCH is the lead agency responsible for public health and mental health issues. Assigned responsibilities include: Coordinate the investigation and control of communicable disease and provide laboratory support for communicable disease diagnostics. Coordinate the allocation of medications essential to public health, including acquisition of medications from federal pharmaceutical stockpiles. Issue health advisories and protective action guides to the public. Coordinate appropriate medical services, providing support to hospitals, pre-hospital and alternate care settings in the medical management of mass casualty incidents. Provide technical assistance in the coordination of emergency medical services. Coordinate with local health departments, community mental health agencies, and state operated inpatient facilities. Provide liaison to federal emergency health and medical programs and services. Coordinate with the National Disaster Medical System. Ensure health facilities have emergency procedures. As required by the Emergency Management Act, MDCH has provided and continuously updates response plans and annexes related to protecting the public抯 health. With regard to communicable disease, these include the Strategic National Stockpile Support Plan, Mass Fatality Plan, MDCH抯 All Hazards Response Plan, Communicable Disease Annex, and the Pandemic Influenza Plan. Module IX of the MDCH All Hazards Response Plan, Communicable Disease Annex, and Pandemic Influenza Response Plan address International and Border Travel Issues. Of note, many of the actual actions would be federal, although the MDCH director could implement orders to control intra-state movement, or recommend to the governor various actions. Public health procedures included in the plans include communicable disease surveillance at borders and travel alerts, warnings or bans. The Emergency Management Act also promotes assistance during a disaster or emergency among local units of government. It provides that municipalities and counties may enter into mutual aid or reciprocal aid agreements or compacts with other counties, municipalities, public agencies, federally recognized tribal nations, or private sector agencies, or all of these entities. A compact entered into under this provision is limited to the exchange of personnel, equipment, and other resources in times of emergency, disaster, or other serious threats to public health and safety. The arrangements shall be consistent with the Michigan emergency management plan. MCL 30.410(2) TA \l 揗CL 30.410(2)� \s 揗CL 30.410(2)� \c 2 . There are no provisions or procedures for inter-jurisdictional cooperation that specifically cover restrictions on the movement of persons during a public health emergency. However, there are numerous agreements for mutual aid or assistance that facilitate response to a public health emergency and could provide resources to implement social distancing measures if needed. These include provisions for sharing personnel, equipment, data, providing notification of disease threats, and providing facilities for treatment or mass prophylaxis. These agreements include: Emergency Management Assistance Compact (EMAC). In 2001, Michigan adopted EMAC, which allows Michigan to operate as a part of the Interstate Mutual Aid Compact. See MCL 3.1001 TA \l 揗CL 3.1001� \s 揗CL 3.1001� \c 2  (covering personnel) and MCL 3.991 TA \l 揗CL 3.991� \s 揗CL 3.991� \c 2  (covering equipment). Consequently, once an emergency has been declared, Michigan has the authority to assist other states in an emergency and seek assistance from other states. This is of particular importance because the Interstate Mutual Aid Compact gives the state providing assistance a right to seek compensation for the services/assistance that it provides to the requesting state. Michigan Emergency Management Assistance Compact (MEMAC). Under the Emergency Management Act, MCL  TA \s 揗CL 30.410(2)� 30.410(2), Michigan has developed a mutual aid agreement for adoption by local units of governments known as the Michigan Emergency Management Assistance Compact that may be found at  HYPERLINK "http://www.michigan.gov/documents/MEMACFINAL7-3-03_69499_7.pdf"
http://www.michigan.gov/documents/MEMACFINAL7-3-03_69499_7.pdf MEMAC is entered into between the Michigan State Police Emergency Management and Homeland Security Division on behalf of the State of Michigan, and by and among each county, municipality, township, federally recognized tribal nation and interlocal public agency that executes the agreement and adopts its terms and conditions. MEMAC is designed to help Michigan抯 local governments share vital public safety services and resources more effectively and efficiently. MEMAC covers serious threats to public health and safety of sufficient magnitude that the necessary public safety response threatens to overwhelm local resources and requires mutual aid or other assistance. Typically, there would be a local, state or federal declaration of emergency or disaster; however, a declaration is not required. There are 1,858 local governments in the State of Michigan. This includes 83 counties, 1,242 townships, 272 cities, and 261 villages. As of July 25, 2007, the number of local governments that have adopted resolutions to participate in MEMAC is 104, including: Counties � 25 (30%) Townships � 41 (3%) Cities � 32 (18%) Villages � 6 (2%) See Appendix 3 for a list of local jurisdictions within Michigan that participate in MEMAC. Mutual Aid Agreements within Regional Medical Biodefense Networks. The State of Michigan has organized eight (8) regional medical biodefense networks that include hospitals, medical control authorities, life support agencies, and other health care facilities. As part of their disaster planning objectives, the regions have been working to develop mutual aid agreements. To date, regions 1, 5 and 8 have adopted agreements. The other five regions continue to work on this. Mutual Aid Agreements among Local Health Departments. There are 45 local health departments in the State of Michigan, including: 30 single-county health departments 14 multi-county, district health departments 1 city health department In addition to their participation in MEMAC, by virtue of their governing entity抯 participation, some local health departments have also executed mutual aid agreements with neighboring local health departments. These agreements vary widely in terms of their scope and content. For example, the Southeast Michigan Local Health Department Mutual Aid Consortium Agreement is a relatively comprehensive mutual aid agreement. It was designed for participation by seven single-county health departments and one city health department. Mutual Aid for Police Assistance. Under MCL 123.811 et seq. TA \l 揗CL 123.811 et seq.� \s 揗CL 123.811 et seq.� \c 2 , two or more counties, cities, villages, or townships, whether adjacent to each other or not, may enter into agreements to provide mutual police assistance to one another in case of emergencies. (Individuals preparing this report do not know the extent of agreements between law enforcement agencies under this law). Provisions or procedures governing the relationships between superior and inferior jurisdictions? (Include relationships among all levels of government and the federal government. See also section I-C above specifically related to quarantine orders.) The Emergency Management Act requires that the Department of State Police establish an emergency management division for the purpose of coordinating within the state the emergency management activities of county, municipal, state, and federal governments. The division is responsible for the Michigan emergency management plan, shall propose and administer statewide mutual aid compacts and agreements, and shall cooperate with the federal government and any public or private agency or entity in achieving emergency management activities. MCL  TA \s 揗CL 30.407a� 30.407a. What is the legal authority of the jurisdiction to accept, utilize, or make use of federal assistance? The Emergency Management Act provides that 搖pon declaring a state of disaster or emergency, the governor may seek and accept assistance, either financial or otherwise, from the federal government, pursuant to federal law or regulation.� MCL 30.404(2) TA \l 揗CL 30.404(2)� \s 揗CL 30.404(2)� \c 2 . Further, the emergency management division of the State Police 搒hall receive available state and federal emergency management and disaster related grants-in-aid and shall administer and apportion the grants according to appropriately established guidelines to the agencies of this state and local political subdivisions.� MCL TA \s 揗CL 30.407a�  30.407a. The Emergency Management Act also states that the governor may enter into a reciprocal aid agreement or compact with the federal government, subject to the limitations described in 1, above (page 20). MCL  TA \s 揗CL 30.404(3)� 30.404(3). B. Sufficiency of powers/authorities to cooperate with other jurisdictions during a declared public health emergency � Discuss the sufficiency of the authorities and powers to cooperate with other jurisdictions during a declared public health emergency, and any potential gaps or uncertainties in those powers and authorities. Potential gaps? There are liability, workers compensation, and reimbursement questions outstanding. Current emergency response plans for communicable disease do not include provisions for limiting the usage of mass transit. Uncertainties? Liability, workers compensation, and reimbursement questions. Legal provisions that could inhibit, limit, or modify the jurisdiction抯 legal basis to cooperate with other jurisdictions? (Examples: state administrative practice acts, specific provisions in law related to inter-jurisdictional cooperation.) The approval of the state administrative board is required for the governor to enter into a reciprocal aid agreement or compact under the Emergency Management Act, MCL  TA \s 揗CL 30.404(3)� 30.404(3). C. Legal provisions/procedures for inter-jurisdictional cooperation on restricting the movement of persons in the absence of a declared public health emergency � What provisions or procedures under law apply to giving and receiving assistance and otherwise working with other jurisdictions regarding restrictions of movement of persons in the absence of a declared public health emergency? Provisions or procedures governing the relationships among superior jurisdictions? Among inferior jurisdictions? Subject to provisions of general law, the Michigan Constitution authorizes the state, any political subdivision, any governmental authority, or any combination thereof to enter into agreements for the performance, financing or execution of their respective functions, with any one or more of the other states, the United States, the Dominion of Canada, or any political subdivision thereof unless otherwise provided in Michigan抯 Constitution. Const 1963, Art III, � 5 TA \l 揅onst 1963, Art III, � 5� \s 揅onst 1963, Art III, � 5� \c 7 . Additionally, any unit of government is authorized to enter into an interlocal agreement under Michigan抯 Urban Cooperation Act, MCL 124.501 et seq. TA \l 揗CL 124.501 et seq.� \s 揗CL 124.501 et seq.� \c 2 , to exercise jointly with any other public agency of this state, another state, a public agency of Canada, or with any public agency of the U.S. government any power, privilege, or authority that the agencies share in common and that each might exercise separately. MCL 124.504 TA \l 揗CL 124.504� \s 揗CL 124.504� \c 2 . The Public Health Code authorizes both the state and local health departments to 揫e]nter into an agreement, contract, or arrangement with governmental entities or other persons necessary or appropriate to assist the department in carrying out its duties and functions.� MCL 333.2226(c) TA \l 揗CL 333.2226(c)� \s 揗CL 333.2226(c)� \c 2 , MCL 333.2435(c)(e) TA \l 揗CL 333.2435(c)(e)� \s 揗CL 333.2435(c)(e)� \c 2 . Under PA 89 of 1935, MCL 798.101 et seq. TA \l 揗CL 798.101 et seq.� \s 揗CL 798.101 et seq.� \c 2 , the governor has the power to enter into interstate compacts with other states to address criminal behavior. The governor is authorized to enter into agreements or compacts with other states, for cooperative effort and mutual assistance in the prevention of crime and in the enforcement of the penal laws and policies of the contracting states and to establish agencies, joint or otherwise, as may be deemed desirable for making effective such agreements and compacts. MCL 798.103 TA \l 揗CL 798.103� \s 揗CL 798.103� \c 2 . The intent and purpose of this act is to grant to the governor administrative power and authority if and when conditions of crime make it necessary to bind the state in a cooperative effort to reduce crime and to make the enforcement of the criminal laws of agreeing states more effective. Any interstate compact must not be inconsistent with the laws of Michigan, the agreeing states, or of the United States. Agreements may be developed and implemented under these laws, whether or not an emergency has been declared. Additionally, with the exception of EMAC, all of the agreements described in Section III on inter-jurisdictional cooperation may be implemented in the absence of a declared public health emergency, as well as during a declared emergency. With regard to state and local health departments, declaration of an emergency or disaster does not relieve any state or local official, department head, or agency of its normal responsibilities. Nor does declaration limit or abridge the power, duty, or responsibility of the chief executive official of a county or municipality to act in the event of a disaster or emergency except as expressly set forth in the Michigan Emergency Management Act. MCL 30.417(e),(f) TA \l 揗CL 30.417(e),(f)� \s 揗CL 30.417(e),(f)� \c 2 . However, if the governor has declared an emergency or disaster, each state department and agency must cooperate with the state抯 emergency management coordinator and perform the services that it is suited to perform in the prevention mitigation, response to, or recovery from the emergency or disaster, consistent with the state emergency management plan. MCL  TA \s 揗CL 30.408� 30.408. Current agreements among superior or inferior jurisdictions include: Great Lakes Border Health Initiative (GLBHI). MDCH is a member of the GLBHI, along with the state health departments of Minnesota, New York, Ohio, Pennsylvania, and Wisconsin, and the Ontario Ministry of Health and Long-Term Care. GLBHI is funded by the Centers for Disease Control and Prevention抯 Early Warning Infectious Disease Surveillance (EWIDS) project, and aims to formalize relationships between U.S. and Canadian public health and emergency preparedness agencies responsible for communicable disease tracking, control and response. The member jurisdictions of Michigan, Minnesota, New York, Wisconsin, and Ontario have entered into a data sharing agreement, which is intended to improve early warning and infectious disease surveillance by facilitating the sharing of infectious disease information and establishing a protocol for communications. Ohio and Pennsylvania are expected to join the agreement once outstanding questions have been answered. Mutual assistance agreements for equipment, specialized personnel, and services may be developed in the future. Agreements with Indian Tribes. A Memoranda of Understanding has been signed between one of Michigan抯 local health departments and a federally-recognized tribe to use a tribal facility as a Strategic National Stockpile dispensing facility. Two of Michigan抯 federally recognized tribes (Sault St. Marie Chippewa and Bay Mills Indian Community) have entered into mutual assistance agreements with the Chippewa County Health Department regarding notification of an occurrence of disease that may cause widespread illness. The Chippewa County Health Department and the Sault Ste. Marie Tribe of Chippewa Indians have also signed a mutual aid agreement regarding use of tribal property to provide mass health care in an emergency. Provisions or procedures governing the relationships between superior and inferior jurisdictions? (Include relationships among all levels of government and the federal government. See also section I-C above specifically related to quarantine orders.) Under the Public Health Code, MDCH and local health departments have concurrent authority over the prevention and control of diseases within the local health department抯 jurisdiction. Both have powers to issue emergency orders and take other action as appropriate to address an imminent danger, epidemic, or other public health emergency. In exercising their authority, the state and local health departments must cooperate and coordinate their responses. MDCH has jurisdiction statewide. If MDCH抯 director determines that conditions anywhere in the state constitute a menace to the public health, she has the authority to take full charge of the administration of applicable state and local health laws, rules, regulations, and ordinances. MCL  TA \s 揗CL 333.2251(3)� 333.2251(3). Further, while disease prevention and control programs are primarily the responsibility of local public health, MDCH抯 director can take primary responsibility as warranted by circumstances. MCL 333.2235(2) TA \l 揗CL 333.2235(2)� \s 揗CL 333.2235(2)� \c 2 . What is the legal authority of the jurisdiction to accept, utilize, or make use of federal assistance? MDCH and local health departments are authorized to receive grants from the federal government, in accordance with the law, rules and procedures of the state (and local governing unit with regard to local health departments). MCL 333.2226(e) TA \l 揗CL 333.2226(e)� \s 揗CL 333.2226(e)� \c 2 , 333.2435(e) TA \l 揗CL 333.2435(e)� \s �333.2435(e)� \c 2 . As discussed above, the Public Health Code authorizes both the state and local health departments to enter into an agreement, contract, or arrangement with other governmental entities, which would include the federal government. D. Sufficiency of powers/authorities to cooperate with other jurisdictions in the absence of a declared public health emergency � Discuss the sufficiency of the authorities and powers to cooperate with other jurisdictions in the absence of a declared public health emergency, and any potential gaps or uncertainties in those powers and authorities. Potential gaps? None Uncertainties? With the exception of EMAC, individuals preparing this report do not know whether Congress has given its consent to the state entering into agreements with other states or provinces. Further, it is not always clear when Congressional consent is required. Individuals preparing this report do not know the extent of inter-jurisdictional agreements that concern law enforcement and the existence of other agreements not discussed in this report that are relevant to inter-jurisdictional cooperation regarding a serious communicable disease outbreak. Legal provisions that could inhibit, limit, or modify the jurisdiction抯 legal basis to cooperate with other jurisdictions? (Examples: state administrative practice acts, specific provisions in law related to inter-jurisdictional cooperation.) None known. E. Interagency/inter-jurisdictional agreements on restricting movement of persons � Where available, identify and provide copies of all interagency and inter-jurisdictional agreements (both interstate and intrastate) relating to restrictions on the movement of persons during public health emergencies and the enforcement of such restrictions As discussed above, there are no provisions or procedures for inter-jurisdictional cooperation that specifically cover restrictions on the movement of persons during a public health emergency. However, the laws and agreements discussed above would facilitate response to a public health emergency and could provide resources to support social distancing measures if needed.  IV. Closure of Public Places A. Legal powers/authorities to order closure of public places during a declared public health emergency � What are the powers, authorities, or procedures to enable, support, authorize, or otherwise provide a legal basis for closure by state or local officials of public places (e.g., public facilities, private facilities, and business) during a declared public health emergency? For each of the jurisdiction抯 legal powers, authorities, and procedures including, but not limited to, umbrella, general public health, or emergency powers or authorities, that could be used to authorize, prohibit, or limit closure, please address the following issues: What are the powers and authorities authorizing closure? The governor is empowered to declare a disaster or emergency under circumstances where there is the threat or occurrence of widespread loss of life or injury. If the declaration involves a health emergency, an important component of mitigation would be limiting the exposure of well persons to those carrying the disease. Inasmuch as people may be infectious before they are symptomatic, closing places where large numbers of people gather in close proximity to one another may be the single most effective mitigation measure to be undertaken by the department. Accordingly, the governor, under the authority of the Emergency Management Act to direct such action 搘hich are necessary and appropriate under the circumstances,� may order the closure of public places and cancellation of public gatherings if the closures and cancellations are needed to protect the public health from spread of pandemic influenza. What are the powers and authorities prohibiting closure? None known. But, there may be compensation issues. Who can declare or establish closure? Under the Emergency Management Act, such orders are issued by the governor. Who makes the decision to close a public place? Same as above. What is the process for initiating and implementing closure? No specific process is provided in the Emergency Management Act once a declaration is made. What is the process for enforcing closure and who enforces it? Violations of executive orders are crimes and may be enforced by any law enforcement officer. What are the penalties for violating closure? Violation is a misdemeanor punishable by 90 days jail, a $500 fine, or both. What are the procedural and due process requirements for closure? The requirements depend on whether an order requiring closure is considered a 搕aking� of property, requiring due process and compensation. See D.1. below (pages 32-33). Is compensation available for closure? If so, what is it? Not specifically provided. But some question exists. See MCL 30.406 TA \l 揗CL 30.406� \s 揗CL 30.406� \c 2 , which addresses compensation for property and services, providing 揷ompensation for property shall be paid only if the property is taken or otherwise used in coping with a disaster or emergency and its use or destruction is ordered by the governor or the director. A record of all property taken or otherwise used under this act shall be made and promptly transmitted to the office of the governor.� How long can a closure last? 28 days unless extended by joint resolution of the legislature. How can it be renewed? By joint resolution of the legislature. Describe the authority/process/notice requirements for ending a closure. If ended by executive order, notice of termination is same as order of closure; by such means calculated to bring it to the attention of the general public. B. Sufficiency of powers/authorities to authorize closure of public places during a declared public health emergency � Discuss the sufficiency of the authorities and powers to authorize closure of public places during a declared public health emergency, and any potential gaps or uncertainties in those powers and authorities. Potential gaps? Compensation is the main question. Uncertainties? Same as above. Legal provisions that could inhibit, limit, or modify the jurisdiction抯 authority to close public places? (Examples: state administrative practice acts, specific provisions in law related to closure.) None known. C. Legal powers/authorities to order closure of public places in the absence of a declared public health emergency � What are the powers, authorities, or procedures to enable, support, authorize, or otherwise provide a legal basis for closure by state or local officials of public places (e.g., public facilities, private facilities, and business) in the absence of a declared public health emergency? For each of the jurisdiction抯 legal powers, authorities, and procedures that could be used to authorize, prohibit, or limit closure, please address the following issues: What are the powers and authorities authorizing closure? What are the powers and authorities prohibiting closure? None known. There may be compensation issues. Who can declare or establish closure? MDCH抯 director and local health officers have the authority to issue an imminent danger order, and require closure of public places as action required to avoid, correct, or remove the imminent danger. Alternatively, the director or local health officer could issue an emergency order to control an epidemic and require closure of public places as a procedure to be followed during the epidemic. Who makes the decision to close a public place? MDCH抯 director or the local health officers for their own jurisdictions. The MDCH Pandemic Plan as well as the Michigan Pandemic Influenza State Operational Plan addresses the potential closure of public places in a moderate (1957-like) or severe pandemic: School dismissals or closures (including daycares and colleges and universities Faith-based organizations Closure of public and private facilities Dismissal of entertainment activities/sports venues, etc Canceling of public gatherings What is the process for initiating and implementing closure? No specific process is set out in the Public Health Code. The process is the same as for issuing any other emergency order. What is the process for enforcing closure and who enforces it? Violation of the orders of MDCH抯 director is a misdemeanor, enforceable by any law enforcement officer. Additionally, MDCH (and local health officers) can go to court to seek enforcement of its orders. MCL  TA \s 揗CL 333.2251(2)� 333.2251(2), MCL  TA \s 揗CL 333.2451(2)� 333.2451(2). The court could punish civilly or criminally via contempt. MDCH (and local health officers) may also maintain injunctive action 搕o restrain, prevent, or correct a violation of a law, rule, or order which the department [local health officer] has the duty to enforce or to restrain, prevent, or correct an activity or condition which the department believes adversely affects the public health.� MCL  TA \s 揗CL 333.2255� 333.2255, MCL  TA \s 揗CL 333.2465� 333.2465. What are the penalties for violating closure? Violation of an order of MDCH抯 director is a misdemeanor, punishable by six months in jail or $200, or both. MCL TA \s 揗CL 333.2261�  333.2261. Enforcement and penalties for violation of a local health officer抯 order depends on local law. What are the procedural and due process requirements for closure? As discussed under 揼aps� below (pages 32-33), MDCH needs to consult with the Department of Attorney General on constitutional parameters. Is compensation available for closure? If so, what is it? No. This issue needs to be reviewed and addressed as a legal and a policy issue. How long can a closure last? There is no time limit on any of the state or local health officers� orders; nor is there a renewal requirement. The health officer who issued an emergency order would be responsible for monitoring the conditions that warranted the order, and respond as appropriate by modifying or rescinding the order as conditions change. Notice of any modifications, or rescission, would need to be sufficient to reasonably notify individuals or groups who are subject to the order. How can it be renewed? See answer to 9 above. There is no renewal requirement. Describe the authority/process/notice requirements for ending a closure. Closure is ended the same way it is commenced. An order is issued terminating the prior order closing public places, with notice sufficient to reasonably notify the public. D. Sufficiency of powers/authorities to authorize closure of public places in the absence of a declared public health emergency � Discuss the sufficiency of the authorities and powers to authorize closure of public places in the absence of a declared public health emergency, and any potential gaps or uncertainties in those powers and authorities. Potential gaps? Closing public places, and related prohibitions on gatherings, raise several issues under the United States and Michigan Constitutions. Under the Michigan Constitution, these include: No person shall be deprived of liberty or property without due process of law. Const  TA \s 揅onst 1963, Art I, � 17� 1963, Art I, �17. Freedom of assembly, free speech, and religion. Art I Ё3, 4, 5 TA \l 揅onst 1963, Art I Ё3, 4, 5� \s 揂rt I Ё3, 4, 5� \c 7 . Eminent domain; private property shall not be taken for public use without just compensation. Const 1963, Art X, �2 TA \l 揅onst 1963, Art X, �2� \s 揅onst 1963, Art X, �2� \c 7  MDCH will need to obtain legal advice from the Department of Attorney General on constitutional parameters for closing public places, prohibiting gatherings, and measures to restrict movement. Procedures and process need developed based both on legal and policy considerations. Uncertainties? See answer above. Legal provisions that could inhibit, limit, or modify the jurisdiction抯 authority to close public places? (Examples: state administrative practice acts, specific provisions in law related to closure.) Only those already noted. V. Mass Prophylaxis Readiness A. Legal powers/authorities for issuance of blanket prescriptions and use of other mass prophylaxis measures during a declared public health emergency � If it became necessary during a declared public health emergency to issue blanket prescriptions or order the use of other mass prophylaxis measures to enable emergency mass distribution of medical countermeasures (e.g., antivirals, vaccines), what legal powers, authorities, and procedures could enable, support, authorize or otherwise provide a legal basis for doing so? List all legal powers and authorities, policies, and procedures that could be used to authorize blanket prescriptions or other mass prophylaxis measures. For each of the powers and authorities listed, please address: Who would make the decision to issue the blanket prescriptions or use other mass prophylaxis measures? In a declared state of emergency the governor can suspend the regulatory statutes and regulations that would in any way hinder or delay necessary action in coping with the emergency or disaster. MCL 30.405(1)(a) TA \l 揗CL 30.405(1)(a)� \s 揗CL 30.405(1)(a)� \c 2 . The governor is further authorized to utilize all available resources of the state government and each political subdivision of the state as reasonably necessary to cope with the emergency or disaster. MCL TA \s 揗CL 30.405(1)(b)�  30.405(1)(b). Under a declared state of disaster or emergency the governor could authorize a suspension of the statutory and regulatory requirements for prescriptions. The governor could directly authorize for mass prescribing and dispensing of vaccines, antivirals and other medications by others such as nurses, dentists, veterinarians and Emergency Medical Technicians (EMT). Who has the authority to issue the blanket prescriptions or order the use other mass prophylaxis measures? Under the Emergency Management Act, the power to order the use of mass prophylaxis is given to the governor. Since the governor does not meet the licensing requirements for a 損rescriber,� she cannot issue blanket prescriptions unless she suspends the statutory and regulatory requirements for prescriptions. The Director of MDCH also has the legal authority to order the use of mass prophylaxis, and the Chief Medical Executive for MDCH has the authority to issue blanket prescriptions. Under the Michigan Emergency Management Plan (MEMP), which is consistent with the National Response Plan, MDCH is the lead agency for Emergency Support Function (ESF) #8. ESF #8 concerns the public health and mental health needs of the community, and includes coordinating the allocation of medications essential to public health and appropriate medical services. Thus, decisions regarding mass prophylaxis will most likely be made by the MDCH Director, with advice from the Chief Medical Executive, in addition consultation from the OPHP Director, the State Epidemiologist, and other Executive Staff or subject matter experts. How would the countermeasures be distributed? The Emergency Management Act does not specifically address distribution of countermeasures. However, detailed distribution plans for countermeasures for each federal stage/WHO phase are part of the MDCH Pandemic Influenza Plan and the MDCH Strategic National Stockpile Plan. Response includes: Receipt, storage and distribution of Strategic National Stockpile to local jurisdictions (carried out by MDCH抯 Office of Public Health Preparedness, as set out in the SNS Plan) Coordinating local health department mass vaccination clinics Monitoring of antiviral or vaccine administration with the Michigan Care Improvement Registry (MCIR) Monitoring of vaccine administration with MCIR Monitoring of adverse effects (VAERS, AERS) Dispensing of antibiotics for post-exposure prophylaxis (CME抯 Standing Orders/ local medical directors Standing Orders) from bioterror or communicable disease agent Dispensing of KI in a nuclear emergency Dispensing chemical or biological agent remedies MEDDRUN is a state resource Chempack is a federal resource for chemical response Distribution will depend upon the event. Mobilization of the SNS requires a Governor抯 Order, but local and state resources have to be depleted first. Before that MEDDRUN and CHEMPACK can be mobilized emergently within the first 24-48hours of an event. SNS Plans and the MEPPP address the procedures for such counter measures. Mass Dispensing Plans and Mass Vaccination Plans are outlined for every Local Health Department. Vaccine and antiviral countermeasure distribution plans are in place within the SNS Plan for Pandemic influenza, and distribution will occur pre-event; that is, in WHO Phases 4 and 5, so as to pre-position resources. B. Sufficiency of authorities/procedures to issue blanket prescriptions or order the use of other mass prophylaxis measures during a declared public health emergency � Discuss the sufficiency of the authorities and powers to issue blanket prescriptions or order the use of other mass prophylaxis measures during a declared public health emergency, and any potential gaps or uncertainties in those powers and authorities. Potential gaps? None known. Uncertainties? None known. Legal provisions that could inhibit, limit, or modify the jurisdiction抯 authority to issue blanket prescriptions or order the use of other mass prophylaxis measures? (Examples: state administrative practice acts, specific provisions in law related to blanket prescriptions/mass prophylaxis.) None known. C. Legal powers/authorities for issuance of blanket prescriptions and use of other mass prophylaxis measures in the absence of a declared public health emergency � If it became necessary in the absence of a declared public health emergency to issue blanket prescriptions or order the use of other mass prophylaxis measures to enable emergency mass distribution of medical countermeasures (e.g., antivirals, vaccines), what legal powers, authorities, and procedures could enable, support, authorize or otherwise provide a legal basis for doing so? List all legal powers and authorities, policies, and procedures that could be used to authorize such blanket prescriptions or order the use of other mass prophylaxis measures. For each of the powers and authorities listed, please address: Who would make the decision to issue the blanket prescriptions or use other mass prophylaxis measures? State and local public health would operate under the authority of the Public Health Code. The director of MDCH, and the local health officers, would make the decision whether to use mass prophylaxis measures, in consultation with the chief medical executive or medical director. If MDCH抯 director is not a physician, the director must designate a physician as chief medical executive who is responsible to the director for the medical content of policies and programs. MCL 333.2202(2) TA \l 揗CL 333.2202(2)� \s 揗CL 333.2202(2)� \c 2 . Similarly, if a local health officer is not a physician, a physician must be appointed as medical director 搑esponsible for developing and carrying out medical policies, procedures, and standing orders and for advising the administrative health officer on matters related to medical specialty judgments. R 325.13001 TA \l 揜 325.13001� \s 揜 325.13001� \c 4 . Who has the authority to issue the blanket prescriptions or order the use other mass prophylaxis measures? The director of MDCH, and the local health officer for his or her jurisdiction, have the authority to order the use of mass prophylaxis measures. Most likely, this would be done as an emergency order to respond to an imminent threat or danger to the public health or as an emergency order to address an epidemic. MCL  TA \s 揗CL 333.2251� 333.2251,  TA \s 揗CL 333.2253� 333.2253,  TA \s �333.2451� 333.2451,  TA \s �333.2453� 333.2453. If the state or local health officer is not a physician, blanket prescriptions would need to be issued by the chief medical executive or medical director. Standing orders for prescriptions and protocols for administering are already in place for pandemic influenza for mass dispensing sites. When MDCH approves a mass immunization program to be administered in the state, health personnel employed by a governmental entity who are required to participate in the program, or any other individual authorized by the director or a local health officer to participate in the program without compensation, are not liable to any person for civil damages as a result of an act or omission causing illness, reaction, or adverse effect from the use of a drug or vaccine in the program, except for gross negligence or willful and wanton misconduct. MCL 333.9203(3) TA \l 揗CL 333.9203(3)� \s 揗CL 333.9203(3)� \c 2  How would the countermeasures be distributed? Mass vaccination clinics, Points of Distribution sites- see local and State Mass Dispensing/ Vaccination and the SNS plans D. Sufficiency of authorities/procedures to issue blanket prescriptions or order the use of other mass prophylaxis measures in the absence of a declared public health emergency � Discuss the sufficiency of the authorities and powers to issue blanket prescriptions or order the use of other mass prophylaxis measures in the absence of a declared public health emergency, and any potential gaps or uncertainties in those powers and authorities. Potential gaps? None known. Uncertainties? None known. Legal provisions that could inhibit, limit, or modify the jurisdiction抯 authority to issue blanket prescriptions or order the use of other mass prophylaxis measures? (Examples: state administrative practice acts, specific provisions in law related to blanket prescriptions mass prophylaxis.) The Public Health Code recognizes the right of individuals to refuse medical treatment, testing, or examination based on religious beliefs. MCL 333.5113 TA \l 揗CL 333.5113� \s 揗CL 333.5113� \c 2 . This right is not absolute, however, and a court may impose certain conditions on a carrier of a serious communicable disease who is a health threat to others under Part 52 of the Public Health Code, MCL 333.5201 et seq. TA \l 揗CL 333.5201 et seq.� \s 揗CL 333.5201 et seq.� \c 2  Conclusion Michigan has many laws, response plans, and agreements in place for effective response to pandemic influenza, including pharmaceutical and social distancing measures. Completing this assessment has been valuable to identify areas of law that require further research, discussion, and development of process and procedures. This is especially true for social distancing measures that implicate constitutional rights of due process, freedom of religion, freedom of speech and assembly, and compensation for private property taken for the common good. Participating in this project has also emphasized the importance of policy and ethical considerations, as well as legal issues, in planning/implementing response measures to pandemic influenza. For example, the closure of businesses results in loss of income to the business owner. This raises legal - as well as policy and ethical questions - about the burden on the business owner for the common good. Similarly, the single mother without sick leave bears the burden of loss of income by home quarantine because she happened to be on a plane with sick passengers. Completing this assessment has also helped identify potential gaps in response plans involving particular measures (such as mass transit limitations and curfew) and highlighted some logistical challenges (such as enforcement of measures). From this assessment it appears that several areas need to be pursued further with other government partners, namely implementation of social distancing measures involving Michigan's constitutionally created universities, on federal lands, and on Indian land. VI. Other Issues A. Other resources (legal powers and authorities, plans, policies or procedures, etc.) that your state might employ or rely upon to assist in pandemic response and the implementation of social distancing measures and/or mass prophylaxis readiness? In addition to resources described above, the Attorney General抯 Office is completing a bench book covering public health emergencies. MDCH抯 Director issued a memorandum in July 2004 explaining to health care providers that the HIPAA privacy rule does not impact state law requiring that identifiable patient information be provided to public health staff related to the prevention and control of serious communicable disease. This memorandum is in both hard copy and electronic form and widely available to assist public health staff address concerns or refusal to provide requested health information based on HIPAA. B. Other such resources (e.g., laws, regulations, or policies; money, personnel, research, training) you do not currently have but would like to have? If so, what are they? It appears that all levels of government have concerns about the source(s) of funding to implement restrictions on movement and social distancing measures. C. Anything unique to your state in terms of pandemic preparedness and response measures related to social distancing or mass prophylaxis? Michigan has the second highest person volume crossing (after New York) from Ontario to the United States, including three bridges and one tunnel. In addition to entry through the U.S./Canadian border, Michigan has four international airports. VII. Table of Authorities Attach a Table of Authorities as an appendix to the report, listing citations for all relevant legal authorities or procedures, including statutes, regulations, case law, Attorney General opinions, etc. Please list the code section or citation, followed by the text and a hyperlink, if available. A Table of Authorities is provided as Appendix 1. TABLE OF AUTHORITIES  TOA \h \c "1" \p Cases By Lo Oil Co v Dept of Treasury, 267 Mich App 19 (2005) 12 National Pride at Work, Inc v Governor, 274 Mich App 147 (2007) 14 People v Board of Education of City of Lansing, 224 Mich 388 (1923) 8 Rock v Carney, 216 Mich 280 (1921) 8, 15  TOA \h \c "2" \p Statutes MCL 10.31 16 MCL 10.33 17 MCL 123.811 et seq. 23 MCL 124.501 et seq. 24 MCL 124.504 24 MCL 24.231 et seq. 14 MCL 3.1001 21 MCL 3.991 21 MCL 30.401 et seq., Michigan Emergency Management Act, 1976 PA 390 3 MCL 30.402(e) 4 MCL 30.402(h) 4 MCL 30.403 5, 16 MCL 30.403(1) 4 MCL 30.404(2) 23 MCL 30.404(3) 20, 23, 24 MCL 30.405 7 MCL 30.405(1)(a) 32 MCL 30.405(1)(b) 4, 32 MCL 30.405(1)(f) 4 MCL 30.405(1)(g) 4 MCL 30.405(1)(j) 4 MCL 30.405(2) 4, 5, 17 MCL 30.406 29 MCL 30.407 16 MCL 30.407a 20, 23 MCL 30.408 20, 25 MCL 30.410 16 MCL 30.410(2) 21 MCL 30.411 5, 13 MCL 30.417(e),(f) 25 MCL 333.1111(2) 8 MCL 333.1291 11 MCL 333.2202(2) 35 MCL 333.2221(2)(g) 9 MCL 333.2226(c) 24 MCL 333.2226(d) 8 MCL 333.2226(e) 26 MCL 333.2228 13 MCL 333.2235(2) 26 MCL 333.2251 17, 35 MCL 333.2251(1) 9 MCL 333.2251(2) 11, 30 MCL 333.2251(3) 9, 26 MCL 333.2251(4)(a) 9 MCL 333.2251(4)(b) 9 MCL 333.2253 10, 17, 35 MCL 333.2255 11, 31 MCL 333.2261 11, 18, 31 MCL 333.2401 � 333.2498 9 MCL 333.2433(2)(f) 9 MCL 333.2435(c)(e) 24 MCL 333.2435(e) 26 MCL 333.2451 17, 35 MCL 333.2451(2) 11, 30 MCL 333.2453 17, 35 MCL 333.2453(2) 10, 13 MCL 333.2455 10 MCL 333.2465 11, 31 MCL 333.2465(2) 13 MCL 333.5113 36 MCL 333.5201 � 333.5207 13 MCL 333.5201 et seq. 36 MCL 333.5201(1)(a) 10 MCL 333.5201(1)(b) 10 MCL 333.9203(3) 35 MCL 333.9207 33 MCL 750.504 5, 17 MCL 764.15(1)(d) 6, 11 MCL 798.101 et seq. 25 MCL 798.103 25  TOA \h \c "3" \p Other Authorities OAG, 1967-1968, No 4631, p 194 (March 5, 1968) 7  TOA \h \c "4" \p Rules R 325.13001 35 R 325.171(g) 10  TOA \h \c "7" \p Constitutional Provisions Const 1963, Art I Ё3, 4, 5 32 Const 1963, Art I, � 17 12, 32 Const 1963, Art III, � 5 24 Const 1963, Art VIII, Ё 5, 6 14 Const 1963, Art X, �2 32   Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States � Early, Targeted, Layered Use of Nonpharmaceutical Interventions, which can be found at  HYPERLINK "http://www.pandemicflu.gov/plan/community/community_mitigation.pdf" http://www.pandemicflu.gov/plan/community/community_mitigation.pdf  The Michigan Association for Local Public Health obtained an assessment of Michigan laws through the Turning Point Collaborative.  This number excludes school districts, intermediate school districts, planning and development regions and special districts and authorities. This information is from the Michigan Manual, p. 711.  Effective April 4, 2006, Michigan amended its law that created the Michigan Child Immunization Registry to expand it to a 揷are improvement registry� that could include immunization information on adults and be used during in an emergency to monitor antiviral or vaccine administration. MCL 333.9207 TA \l 揗CL 333.9207� \s 揗CL 333.9207� \c 2 .     PAGE  PAGE 10 Ffgtv��c d f � � ���� � T�MNabu��� 蜴漳播灇灇瀿厼殲殲zrzc歘歘歘W_Ph2�h2�jh2�U
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