Hawaii Leads In Bioterror Lawmaking


Many states deal with outbreaks of flu, meningitis and lately, diseases like West Nile virus. But Hawaii health officials see numerous cases of more exotic ailments like dengue fever, (a tropical disease spread by mosquitos) and Hanson's disease (a form of leprosy). Sicknesses like these occur because of the island state's tropical climate and proximity to Southeast Asia.

Because its public health authorities regularly confront diseases that most people have never heard of, Hawaii is at the forefront of the fight against bioterrorism. Officials from multiple state agencies and organizations, including the legislature, Department of Health, Department of Public Safety, Attorney General's office and Healthcare Association met following the September 11 attacks on the World Trade Center And the Pentagon to draw up an emergency preparedness plan.

Addressing bioterrorism was "on the back of everyone's desk. September 11 brought it to immediacy," says Bart Aronoff, a planner with the Department of Health and primary author of Hawaii's new measure.

State Senator David Matsuura is spearheading a drive in the legislature to overhaul and streamline the state's emergency health powers so that authorities are on firm constitutional and legal ground if they have to impose quarantines or take other extraordinary steps.

Shortly after the terrorist attacks, Matsuura had lunch with his brother-in-law, who serves as the chief physician for the state's National Guard. When the conversation turned to bioterrorism and what plans were in place in the state, Matsuura says he was surprised at what he heard.

"The only response we had for emergencies was quarantining. Our state's bioterrorism plan was faulty," Matsuura says.

About the same time, Matsuura learned that Washington, D.C. medical law experts had crafted what's known as the Model State Emergency Health Powers Act, a measure designed to help states revamp outdated public health laws and deal better with emergencies.

Matsuura and other state officials took the model act as a blueprint to craft their own bill, which was introduced on January 28 in both chambers.

One part of the bill would cure civil liberties problems with the state's quarantine law, which dates back to 1869. Another provision addresses state agency collaboration in times of disease outbreaks and includes a "hold-harmless" provision for health care facilities, which gives doctors and other health workers some legal immunity for providing care during a crisis.

The health department's Aronoff says updating the quarantine law is long overdue.

"We've known for several years the (quarantine) authority we have wouldn't pass constitutional muster ... what we're doing is reforming the law, giving people the right (to refuse to be isolated) unless there's an emergency situation and (saying) we'll need to get a court order," he says.

Hawaii officials say collaboration between health officials, lawmakers and interest groups like the health care association was key to drafting a measure that everyone, including the governor, now backs. "It was critical to develop good communication with all stakeholders," health department director Bruce Anderson says.

It may not be such an easy task for all states. "We have a small state and it was relatively easy. In a larger state, it will be more difficult," Anderson says.


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