PHOENIX -- State Health Director Will Humble said Tuesday he's not going to automatically quarantine health workers returning to Arizona from West Africa despite widespread public support for the move.
Humble said state law gives county health officials, in consultation with him, the power to do that if they feel it's necessary. He said most of the time people agree to voluntary quarantine.
But Humble the law does provide for mandatory and involuntary quarantine. And he said that power has been used in Arizona from time to time to confine someone -- albeit to this point, tuberculosis patients -- against that person's consent.
Alessandra Soler, executive director of the American Civil Liberties Union of Arizona said her organization has no objection to involuntary quarantine -- if there's a legitimate medical reason.
"When public health officials are imposing quarantine based on politics rather than science and medical science, that raises serious civil liberties concerns,' she said. And Soler also said she wants to be sure that those kept away from each other are not treated as criminals, as was the case in a 2007 incident where the ACLU sued to get a TB patient out of the jail ward of Maricopa Medical Center.
The question comes amid a rising fear of Ebola, fueled by governors in New York, New Jersey and Maine who have insisted that health care workers returning from Sierra Leone, Guinea or Liberia be locked away and monitored.
Two separate national polls have found that more than seven of every 10 people questioned believe returning health care workers should be separated from everyone else until it is determined they are not infected.
And the public fears were flamed again when a returning nurse challenged an effort by the state of Maine to have her quarantined. She eventually obtained a court order allowing her to remain free -- but only if she monitors her health and reports any symptoms to health officials there.
Humble acknowledged public concerns that a worker -- or even a traveler to those countries -- will spread the disease to others. But he said that protocols by the Centers for Disease Control provide him with less restrictive options than are being pursued elsewhere, restrictions that, in most cases, he believes are appropriate for a disease that medical experts say is transmitted only in bodily fluids of people showing symptoms of the disease.
The least restrictive is "active monitoring.' Humble said that's applied to those who have visited one of the three countries in the last 21 days.
In essence, they are not restricted in their activities. But they are required to take their own temperature and log it twice a day, keep a list of any symptoms and talk by phone with a public health official daily.
Most health care workers, however, will get more close attention with "direct active monitoring.' He said that means a health worker actually physically visiting the person daily on top of the temperature and symptom logs.
"However, if we get a health care worker that comes back that was working for example in a Doctors Without Borders clinic that had known transmission of Ebola in the last 21 days ... that person we would most likely put under travel restrictions and/or quarantine,' he said. He said that might include a clinic where there was a breach in the "personal protective equipment' that someone at the clinic was wearing. "That's a higher risk of person because they were working in a clinic where we know there was a problem with PPE.'
At the very least, Humble said, there would be travel restrictions: No public transit, no congregate settings, and, in fact, not getting within three feet of anyone else.
Where public health runs into civil rights is over more restrictive moves, like quarantine, where someone is ordered to stay home.
He said this occurs from time to time with patients with TB. But Humble, who has been with the health department since 1992 and been director since 2009, said there's usually no need to force the issue.
"Once you explain it to them and their families they do it voluntarily,' he said.
"Sometimes that means separating the TB patient from the rest of their family, especially if there's kids or any immuno-compromised people,' Humble explained. "However, there are circumstances -- I would say every two years -- where one of the county health departments needs to do a quarantine order on a non-compliant TB patient.'
One of those orders ended up in a court fight.
In 2006 Robert Daniels was ordered locked away after being diagnosed with an extremely drug-resistant strain of TB that he probably would have for his entire life. That order came after county health officials said he was risking public health by not wearing a mask while visiting a convenience store.
Soler, whose organization filed suit on Daniels' behalf, said the issue was not that he was quarantined but that he was locked in a jail cell in the county hospital. She said the ACLU finally got the man released and he went back to his native Russia.
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