Ebola Nurse Quarantined in New Jersey Raises Unique Legal Question

New Jersey Governor Chris Christie made headlines last week by standing by his decision to quarantine a Maine nurse who flew into Newark airport on a flight from Sierra Leone.  Christie’s quarantine, initiated due to heightened concerns over the spread of Ebola in the United States, poses the unique legal question of whether or not a state government has the right to hold travelers without a legal hearing because of public health concerns.

Quarantined Nurse Tells her Story

The saga of Kaci Hickox gained national attention when media outlets across the country published her account of the quarantine, setting off a public debate about the authority states have to institute quarantine of airline passengers based on their country of origin.  Ms. Hickox returned to the United States from Sierra Leone where she had been working on a nursing rotation with Doctors Without Borders, an organization committed to providing medical aid to the Ebola-stricken African nations that don’t have the resources to combat the virus. 

Upon landing at Newark Airport, Hickox was detained by officials who questioned her about her time in West Africa and administered a preliminary test for Ebola.  When she showed signs of a fever, Hickox was taken to a New Jersey hospital where she was told she’d be detained for 21 days as part of the state’s new quarantine procedure.  Although a blood test conducted within days of her quarantine indicated she was Ebola-free, Hickox’s detainment in New Jersey lasted through the weekend until she was permitted to return to Maine on a private shuttle.  Maine officials have agreed to regulate her during the rest of her quarantine period – meaning Ms. Hickox will still not be free from medical care despite returning to her home state.

Kaci’s account, in which she wrote, “This is not a situation I would wish on anyone, and I am scared for those who will follow me,” has become the focus of a national debate on the appropriate response to the Ebola panic.  Legal scholars, government officials, and even the President have all weighed in on the issue, which may find its way to court.

White House Questions New Jersey Quarantine Procedures

Among the loudest critics of Governor Christie’s Ebola quarantine was President Obama, whose administration expressed concerns that the process may have unintended consequences that make it more difficult to “combat Ebola at its source.”  Writing that new federal guidelines that fought the spread of Ebola in the US without preventing aid workers from flying to and from African nation countries to administer aid, a senior administration official said that state quarantines could be counterproductive to encouraging health workers from the US to assist African countries in need.

The White House instead has developed a plan that would avoid a broadly administered 21-day quarantine in favor of a more individualized approach that would administer supervision and treatment based on the results of thorough medical tests on returning health care workers.  In an effort to avoid discouraging health care workers from volunteering to travel to and from West African countries with a harsh quarantine procedure, the federal government supports individualized treatment based on the risks each traveler poses.  Citing tests that indicate people who don’t show signs of Ebola cannot transmit the disease, the White House argued that an overbroad quarantine was not only inappropriate, but questionably constitutional.

Legal Debate Over State Quarantine Procedures

Although Nurse Hickox has been released from New Jersey and allowed to serve the remainder of her quarantine at home in Maine, legal questions about Ebola based quarantines remain relevant due to procedures instituted in several states that will, to varying degrees, supervise travelers from West African nations upon their return home.  Central to the argument that quarantine is a constitutional violation is the premise that the policies are over-inclusive because they do not allow for individualized assessment of risk prior to detainment.  Generally, no government may detain a citizen without suspicion, or conviction, of a crime, however, the presence of a public health crisis such as Ebola may provide sufficient justification.

Governor Christie has defended his quarantine by citing state authority to take otherwise impermissible action in order to prevent a public health crisis such as the spread of the Ebola virus.  Saying that he had no second thoughts about quarantining Ms. Hickox, Christie expressed his opinion that the greater concern was for the health of New Jersey’s citizens.  In defending his position, the Governor said, “I’m sorry if in any way she was inconvenienced, but inconvenience that could occur from having folks that are symptomatic and ill out amongst the public is a much, much greater concern of mine. So certainly nothing was done intentionally to try to inconvenience her or try to make her uncomfortable.”

The effort to balance constitutional protections from unwarranted detention with a state’s right to enact procedures that promote public health is a topic the law rarely touches on.  The Supreme Court upheld a smallpox quarantine in the 1960’s, and supported tuberculosis quarantines in the early 1900’s, so any existing legal precedent that may be relevant would likely favor a state’s efforts to prevent the spread of Ebola, even at the expense of individual liberties.

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