States should have the power to restrict the movement of patients with contagious diseases even before they have the chance to disobey doctors' orders, federal health officials say.
The need for such authority to order someone quarantined emerged as lesson No. 1 from the case of the Atlanta lawyer who traveled to Europe despite having a dangerous form of tuberculosis.
"If we believe the patient has a strong intent to put others at risk, we need to have confidence we can take action, absent documentation of intent to cause harm," Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention (CDC), told lawmakers last week.
Dr. Gerberding also mentioned outfitting a CDC plane so the government could fly patients long distances without fear of contaminating others on board and improving communications among government agencies.
Also cited by the Senate Appropriations subcommittee hearing was the lapse at the U.S.-Canadian border that allowed Andrew Speaker to enter the United States even though his name was on a watch list with instructions to detain him. Officials said a lone border agent made a bad decision.
The ability to require that someone be kept in isolation leads to legal and ethical questions about possible overreaching by the government.
"First of all, up front, before the patient left the United States, we believe that we could strengthen our states' ability to restrict the movement of patients before they demonstrate noncompliance with the medical order," Dr. Gerberding told lawmakers.
However, Peter Jacobson, a health law professor, had concerns about Dr. Gerberding's statement.
"That's not the federal government's role and it's far, far too broad a statement. There has to be a credible threat, a direct threat of harm before you restrict someone's freedom to move, before you intrude on their individual liberties," said Mr. Jacobson, director of the Center for Law and Ethics and Health at the University of Michigan.
"For her to say, in such a broad manner, that a state should restrict people before they're noncompliant is extremely intrusive in my view," he said.
Also, the Association of State and Territorial Health Officials, based in Washington and representing state health officials, noted that it is now up to the states, not the federal government, to determine when to issue an isolation order.
Even if Congress went along with Dr. Gerberding's idea, state legislatures seemingly would have to follow with their own changes for the proposal to take effect.
"Each governor does have the ability to quarantine. But the circumstances around it, how it's done and for how long, is tailored to each state," said Paula Steib, communications director for the Association of State and Territorial Health Officials.
Besides granting states more power to isolate patients, Dr. Gerberding said, the federal government should clarify its quarantine laws.