Public Health and Law Enforcement Cooperation

1
Public Health and Law Enforcement Cooperation

• Information Sharing
• Joint Investigations
• NYC DOHMH/NYPD/FBI Protocol

2
Possible Contextual Scenario

• Health officer receives a report of possible
  smallpox case
• Notifies law enforcement and a mutual sharing of
  information takes place
• Jointly go to the hospital to interview and
  investigate
• Possible or confirmed case needs to be isolated
  and civilly detained

3
Framework for Cooperation

• Find or create authority in participating
  agencies enabling laws that will allow
  cooperation
• Work strictly within the respective and
  applicable legal authorities
• Dont lose sight of each others main mission
  avoid mission creep

4
Information Sharing

• Authority probably exists to allow the sharing of
  information if such sharing will benefit the
  mission of the other
• Example, NYC Health Code 11.07(c)
• 
  
  (c)
  Subsections (a) and (b) of this section shall not
  prevent authorized personnel of the Department
  from furnishing appropriate information to a
  physician or institution providing examination or
  treatment to a person suspected of or affected
  with a disease or condition, to an agency
  approved by the Department for prevention,
  treatment or social care, or to any person when
  necessary for the protection of health. A person,
  institution or agency to whom such information is
  furnished or to whom access to records has been
  given, shall not divulge any part thereof so as
  to disclose the identity of the person to whom
  such information or record relates, except
  insofar as such disclosure is necessary for the
  treatment of a case or carrier or for the
  protection of the health of others.

5
Information Sharing (cont.)

• From the public health perspective, decisions
  about what information to share, when to share it
  and when to authorize re-disclosure, must remain
  with the health officer or a small group of
  authorized designees
• Disclosure of information which is reported to
  public health (PH) must be treated as an
  exception

6
Information Sharing (cont.)

• HIPAA is not an obstacle to covered entities,
  like hospitals or doctors, making disclosures to
  PH. HIPAA-permissible disclosures to PH are broad
  and include disclosures required by law (45 CFR
  164.512(a)) and disclosures for authorized PH
  activities, including PH investigations (45 CFR
  164.512(b))
• HIPAA-authorized disclosures to law enforcement
  (LE) are much more limited (45 CFR 164.512(f))

7
Joint Investigations

• In order to maintain the confidence and
  cooperation of the medical community, PH must in
  fact be, and be perceived as, the lead
  epidemiological investigator
• Reporting unusual manifestations of disease
  will always be a medical judgment call (WNV,
  Smallpox)
• If we lose the cooperation of the medical
  community, we will kill the goose that lays the
  golden egg of early warning

8
Joint Investigations (cont.)

• PH has broad authority to conduct
  epidemiological investigations in order to
  ascertain the existence of disease outbreaks, to
  discover the source of infection, unreported
  cases and unknown contacts, and to take whatever
  action is necessary to mitigate morbidity and
  mortality
• LEs investigation into criminal potential or
  actual bioterrorist events will need to focus on
  the same areas, creating a mutuality of interest

9
Joint Investigations (cont.)

• Joint investigations will save time, an important
  consideration in a potential or actual emergency.
  Utilizing each others investigative expertise
  can enhance the quality and outcome of
  investigations for both
• Less disruptive to the health care community to
  have PH involved, utilizing existing
  relationships
• If PH were perceived as an agent of LE, would we
  have to give Miranda warnings when interviewing a
  patient? Would civil detention for isolation and
  quarantine purposes be converted into a criminal
  arrest?

10
NYC DOHMH/NYPD/FBI Protocol

• Benefits of joint investigations were
  acknowledged before 9/11 as a result many false
  white powder jobs
• Initially bilateral protocol discussions were
  between DOHMH and the FBI
• After 9/11 expanded to include NYPD through the
  JTTF

11
Protocol (Cont.)

• Protocol acknowledges that, by statute, the NYPD
  can be called upon to assist DOHMH, that DOHMH is
  not an agent of LE, and that the joint activity
  is essentially an epidemiological investigation
  governed by public health confidentiality
  principles, including NYC Health Code 11.07(c)
• Protocol was signed in October of 2004
• DOHMH is training the NYPD and FBI in the
  techniques and principles of epidemiological
  investigations
• http//www.phppo.cdc.gov/od/phlp/phlegalresponse.a
  spand scroll down to New York City