An Important State Bill to protect citizens from the lessons learned excesses of the Covid-19 era

A case study in reforming state public health: Mandates: access to facilities, employers, vaccinations, quarantine enforcement; off label drug use, informed consent

Introduction

A bill, S.54, passed on April 3 by the SC Medical Affairs Committee, is an important start at protecting its citizens from government excesses of the Covid-19 era. The bill will now go on to the full SC Senate. I recommend that those activists in all states concerned about how your state Public Health department performed during the Covid19 era should read this bill and understand what was included in the bill and why and what was not included in the bill and why.

I would be remiss if I didn’t make these observations before presenting the bill itself:

1. The bill, as written, explicitly omits childhood vaccine mandates. This was considered too hot a potato to handle, even with a Republican supermajority. That is kind of understandable. The legislators don’t have the expertise to evaluate the safety, efficacy, and adverse effects related to the shot schedules (CDC Child and Adolescent Schedule, Adult Schedule). Hopefully the Trump administration, through all its health agencies, will do the job of scientifically evaluating every single shot on the schedules and revise them based on their findings. Furthermore, they should supply the necessary informed consent frameworks as patterns for state legislation based on their findings.)

2. In general, the bill leaves too much power to the administrative branch to “fill in the blanks.” What data are used to evaluate when a medical emergency exists. What should be the content of the informed consent. How to evaluate whether or not the citizen understands the informed consent. And so on.

3. The bill does not explicitly define where a repository of signed informed consents is stored. They should be stored with the patient’s medical records, such as their EMR record.

4. The bill retains the policy that the public health department is the arbitor in deciding what is best for each citizen. This is obvious by the way quarantine is described. My position is that, in the medical emergency context, quarantines should never be administered at the state or any government level. It can be the responsibility of a public health department to recommend that a quarantine be implemented, but the nature of the quarantine should be left to individual medical professionals dealing with individual citizens. It is just impossible to properly define a quarantine that takes into account the variables associated with each individuals, such as the individual’s health history and the family and community situtation.

5. To resolve the medical data issue, I submit that an open “source,” state-wide medical data and analytics system must be established. I’ve discussed the architecture of this system and the management structure in the following substacks: Criteria for a State-wide Medical Database and Analytics System and A Sample Bill Implementation Bill (Note: I fully expect that the new federal administration will develop a national database to replace the hopeless inadequate and innefficient VAERS system. However, I hope they understand that an efficient data architecture and data analytics system, as well as some dependencies, requires that a national system be partitioned into state systems that feed analytics to a national summary database. I can say that at least one subsystem of this system would be best implemented, for cost reasons, to the federal system: the evaluation of pharmaceutical suppliers for quality, both at a plant level and at an individual product level. There might be reasonable question about whether the next subsystem in the flow, evaluating the quality of the logistics system for a pharmaceutical, might be a federal responsibility, but I am thinking not. This subsystem requires sampling up to individual vials at individual dispensing locations, which seems to me to be too detailed to be a federal responsibility. This would best be done by labs at educational institutions, where students could gain experience while at the same time providing an essential service.)

6. To resolve the problem of administrative overreach in defining medical policy, the informed consent forms need to be better defined. I submit that two programs need to be established as part of any comprehensive informed consent procedure. First, the legislature needs to define the entire procedure of informed consent. This bill provides some aspects of a good procedure, but it could do more. Some of the responsibility for this should be at the federal level, with refinements done at the state level. The legislature should defined “frameworks”¹ for both procedures and pharmaceutical information for different citizen groups; eg, children, adolescents, adults, etc.) A framework for a standardized informed consent procedure for both adults and children that includes management requirements, a detailed framework for informed consent forms, a requirement that informed consent be provided by qualified medical staff, not, for example by clerks in a pharmacy at the time a pharmaceutical is being provided to the patient.

The following is the real bill with my comments. The bill contents are indicated by the standard block quote lines of substack. Additions to the legacy text in the law are represented in italics. Deletions to the legacy text are represented by strikethroughs. The bold-face titles are my addition to provide some guidance on the bill’s organization.

Attached to the bottom of this post are some documents used during the compaign by healthcare advocates and bill sponsors to educate the public on the value of the bill.

• A brief summary of the bill for general use

• Two different resolutions passed by the South Carolina Republican Party used in support of the bill. Since SC has a supermajority of Republicans in the legislative and administrative branches of government, these resolutions “should” carry a lot of weight.

• An advocacy article written for a state-wide electronic newspaper/blog

In addition to two years of advocating reform on this blog, concerned citizens throughout the state, informed by regional and local activist groups, contacted their legislatures, requesting support of the bill. Open Medical Affairs Meetings on the bill were well attended, compared to typical meetings, to show support for the bill.

As mentioned at the beginning of this post, this bill has a number of hurdles to jump before it becomes law:

1. Full Senate approval: three different “readings/votes,” which might include amendments

2. House Medical Committee review and approval (This committee is called MMM in SC)

3. Full House approval: same process as in the Senate

4. Governor signing

This post should be read and understood by all citizens and legislators and citizens should contact their legislators to support the Bill. This post should also be useful to other states as they attempt to reform and reestablish integrity in both the legislative process and in Public Health Departments.

I do beg your forgiveness if you find errors in copying the bill to this substack. The substack editor does not support the various format techniques used by the clerk who types the bill as a Word document. I have to go through the bill and struggle to make appropriate modifications to put it in the substack post. If I’ve missed something, please let me know and I’ll correct the mistake.

Mandates Involving Customers and Employment Preconditions

Definitions

S.54, The Medical Informed Consent Act, provides these definitions, added to the end of Title 16, Chapter 17. (Title 16 is called “Crimes and Offenses;” Chapter 17 is called “Offenses Against Public Policy.” This area of the law focuses on barratry, the “act of persistently instigating lawsuits, often groundless ones.” Interesting that these definitions, along with the “Unlawful…” and “Penalties…” in the next paragraphs were moved to that Title):

Section 16-17-780 (A) As used in this section:

(1) “Gene therapy” means any product that mediates its effects by transcription or translation of transferred genetic material or by integrating into the host genome and that are administered as nucleic acids, viruses, or genetically engineered microorganisms;

(2) “Indemnified product” means any product including, but not limited to, a covered countermeasure, for which the manufacturers and distributors are shielded from direct civil or criminal liability to consumers for personal injuries and damages resulting from the use of the product as determined by state or federal law; and

(3) “Vaccine” means a suspension of attenuated or killed microorganisms, or of antigenic proteins derived from them, that is administered for prevention or amelioration of infectious disease which has obtained Emergency Use Authorization, or which has been approved by the U.S. Food and Drug Administration and has been licensed for use.

(Note: I would like to see, somewhere, the mention of LNP (Lipid Nanoparticles) as being defined and that those pharmaceuticals be treated the same as and as specific ingredients that need to be described in informed consent to the same level as the pharmaceutical it is supporting.)

Unlawful to Mandate Regarding Preconditions on Use and Participation

(B) It is unlawful for any person, partnership, for‑profit or non‑profit corporation, limited liability corporation, institution of higher learning, or the State and its political subdivisions and their agents that employ one or more employees to mandate employees, contractors, students, patrons, customers, clients, or guests to receive a vaccine, indemnified product, or gene therapy described in this section as a precondition for employment, entry into buildings and grounds, attendance, participation, or purchase or receipt of any products and services offered.

(Note: This wording could be ambiguous regarding “students,” since “institution of higher learning” is used in the organization list. However, I suspect children are not included in this mandate, which is probably purposeful in order to avoid the controversy regarding child vaccinations.)

Penalties Regarding Preconditions

(C) A person who violates the provisions of this section:

(1) for a first offense, is guilty of a misdemeanor and, upon conviction, must be fined not more than one thousand dollars or imprisoned for not more than one year, or both;

(2) for a second offense, is guilty of a misdemeanor and, upon conviction, must be fined not more than two thousand five hundred dollars or imprisoned for not more than three years, or both; and

(3) for a third or subsequent offense, is guilty of a felony and, upon conviction, must be fined not more than five thousand dollars or imprisoned for not more than five years, or both.

(Note: “A Person” is the only subject mentioned in this section, so I have to wonder how this applies to all the other subjects in the mandate.)

Mandates Involving Labor and Employment

S.54, The Medical Informed Consent Act, provides these definitions and provisions added sections to Title 41, Labor and Employment, Chapter 1, General Provisions:

Definitions

Section 41-1-55.

(A) As used in this section:

(1) “Agent” means any former supervisor or the employer's designee.

(2) “Employer” means any person, partnership, for‑profit or non‑profit corporation, limited liability corporation, or the State and its political subdivisions and their agents who employ one or more employees.

(3) “Employee” means any person employed by an employer.

(4) “Gene therapy” means any product that mediates its effects by transcription or translation of transferred genetic material or by integrating into the host genome and that are administered as nucleic acids, viruses, or genetically engineered microorganisms.

(5) “Indemnified product” means any product including, but not limited to, a covered countermeasure, for which the manufacturers and distributors are shielded from direct civil or criminal liability to consumers for personal injuries and damages resulting from the use of the product as determined by state or federal law; and

(6) “Vaccine” means a suspension of attenuated or killed microorganisms, or of antigenic proteins derived from them, that is administered for prevention or amelioration of infectious disease which has obtained Emergency Use Authorization, or which has been approved by the U.S. Food and Drug Administration, and has been licensed for use.

Employer Prohibitions

(B) Employers are prohibited from taking any adverse pre‑employment or employment action including, but not limited to, discrimination, termination, suspension, involuntary reassignment, unpaid leave, demotion, harassment, coercion, or retaliation against an individual who declines to receive a vaccine, indemnified product, or gene therapy as defined in this section.

Penalties

(C) If an employer violates the provisions of this section, then an aggrieved employee shall have the right to apply for and receive unemployment benefits subject to the benefit amounts, duration, and requirements provided in Article 1, Chapter 35, Title 41, as well as back pay, front pay, lost wages, consequential damages, emotional damages, court and litigation costs, and attorney’s fees.

(D) If an employer willfully or maliciously discriminates or commits a violation of this section, then they shall also be liable to the employee or prospective employee for punitive damages in the treble amount of the actual damages awarded.

(Note: The penalties are essential to this section. They must be strong enough that the employer will definitely feel the hurt if the employer violates one of the prohibitions. This is an essential part of the bill.)

Prescriptions

S.54, The Medical Informed Consent Act, modifies Title 40, Professions and Occupations, Chapter 43, South Carolina Pharmacy Practice Act, to permit refusal to fill a prescription, expanding the definition of that duty. I will include here only the modifications to the section:

Section 40-43-86(E)

(1) A prescription drug order shall contain at a minimum, the:

(f) number of refills authorized. No prescription marked “PRN” or any other nonspecified number of refills may be refilled more than two years beyond the date it was originally written. Nothing in this subsection abridges the right of a pharmacist to refuse to fill or refill a prescription; and

(2) A pharmacist may refuse to fill or refill a prescription when:

(a) a contradiction is detected in the patient’s records;

(b) patterns of narcotic abuse are observed in the patient’s records;

(c) the order is not complete or unclear;

(d) the pharmacist objects to filling the prescription for religious, moral, or ethical reasons pursuant to the Medical Ethics and Diversity Act, Title 44, Chapter 139. Nothing in this subsection allows pharmacists to deny “right to try” prescriptions as defined in Section 44‑137‑10; or

(e) the prescription is for off-label use of the prescribed drug, during a state of emergency declared by the governor, and the patient is unable to pay for the prescription or a pharmacy is under-reimbursed or not reimbursed by the insurance carrier. For purposes of this subitem, “off-label use” means the practice of prescribing a prescription drug for a different purpose than the federal Food and Drug Administration’s approved purpose.

(Note: This section is intended to prevent a pharmacist from denying the prescription and use of pharmaceuticals like Ivermectin. It isn’t clear to me what the financial part of (e ) means. However, this is an essential part of this bill.)

Enforcement of the Orders from Department of Public Health

S.54, The Medical Informed Consent Act, modifies Title 44, Health, Chapter 1, Department of Public Health, in the way the sheriffs and constables are used to enforce orders from the Department of Public Health. In its modified entirety it reads:

Section 44-1-100. All sheriffs and constables in the several counties of this State and police officers and health officers of cities and towns must may aid and assist the Director of the Department of Public Health and must may carry out and obey his orders, or those of the Department of Public Health, to enforce and carry out any and all restrictive measures and quarantine regulations that may be prescribed. During during a state of public health emergency, as defined in Section 44-4-130,. the director may request assistance in enforcing orders issued pursuant to this chapter and pursuant to Chapter 4, Title 44, from the public safety authority, as defined in Section 44-4-130, other state law enforcement authorities, and local law enforcement. The public safety authority may request assistance from the South Carolina National Guard in enforcing orders made pursuant to this chapter or pursuant to Chapter 4, Title 44.

(Note: The key change is to change must to may. This means that the sheriffs and constables don’t have to carry out and obey orders. This is a highly controversial Section of the existing law. The use of the word “must” puts the Director and/or the Department of Public Health, all unelected, above all the elected officials, essentially making them King, or Dictator, … whenever. Why this wasn’t declared unconstitutional long ago is beyond me. One might argue that this only applies during a declared emergency, and they might be right- though the wording in this section isn’t strictly qualified. It is my opinion that the Department of Public Health should NEVER have the power to quarantine for infectious disease alone. It can advise, but not demand and enforce. I don’t believe that should even be a power of the governor. The governor can declare a health emergency, which might activate certain state agencies and powers, but, in this day and age, quarantine is not one of them. The action of quarantine should be left to the citizens’ healthcare provider. The length of time should be left to the healthcare provider. Quarantine is an old concept for disease control and, at least in the US, is not effective if dictated by a politician or an executive branch employee.

On the other hand, notice I said “infectious disease” above. That is important to me. I believe there are conditions of natural disasters where a kind of quarantine would be necessary. I’m thinking of a chemical spill or the burning of toxic chemicals. In that case, those exposed may need quarantine until evaluated and the space where the natural disaster occurred might be quarantined.)

Emergency Health Powers

S.54, The Medical Informed Consent Act, modifies Title 44, Health, Section 4, Emergency Powers. I’ll include here only the important changes or the existing text necessary to understand the powers defined by this section:

Definitions

Section 44-4-130. As used in this chapter:

(K) “Gene therapy” means any product that mediates its effects by transcription or translation of transferred genetic material or by integrating into the host genome and that are administered as nucleic acids, viruses, or genetically engineered microorganisms.

(R)(S) “Qualifying health condition” means:

(1) a natural disaster; or

(2) an illness or health condition that may be caused by terrorism, epidemic or pandemic disease, widespread illness, or a an novel infectious agent or biological or chemical agent and that poses a substantial risk of a significant number of human fatalities, widespread illness, or serious economic impact to the agricultural sector, including food supply incidents of permanent of long-term disability.

(Y) “Vaccine” means a suspension of attenuated or killed microorganisms, or of antigenic proteins derived from them, that is administered for prevention or amelioration of infectious disease which has obtained Emergency Use Authorization, or which has been approved by the U.S. Food and Drug Administration, and has been licensed for use.

Physical examinations or tests; isolation or quarantine of persons refusing examination

Section 44-4-510. Physical examinations or tests; isolation or quarantine of persons refusing examination

(A)(1) During a state of public health emergency, the department may perform voluntary physical examinations or tests as necessary for the diagnosis or treatment of individuals.

(2) The department may isolate or quarantine, pursuant to the sections of this act and its existing powers under Section 44-1-140, any symptomatic person or person who has been exposed to the contagious disease for which the public health emergency has been declared whose refusal of physical examination or testing results in uncertainty regarding whether he or she has been exposed to or is infected with the contagious or possibly contagious disease or otherwise poses a danger to public health.

(B)(1) Physical examinations or tests may be performed by any qualified person authorized to do so by the department.

(2) Physical examinations or tests must not be reasonably likely to result in serious harm to the affected individual.

(3) An exposed person should not be released from quarantine due to a normal physical examination or test result, but should remain in quarantine until the end of the incubation period. Once a person develops symptoms in quarantine, as provided in Section 44-4-530(B)(5), they must be removed to isolation. If they refuse testing or examination, then the isolation period may be affected.

(Notes: So, (A)(2) gives the “may” power to “isolate or quarantine a symptomatic person or person exposed to the contagious disease for which the public health emergency has been declared”, if that person refuses a physical examination or testing and if there is uncertainty regarding whether or not the person is infected. This is an improvement. (B)(1) allows the examinations to be performed by someone authorized by the department. If I had full confidence in the department, this wouldn’t be a problem; however, the experience of the Covid-19 era gives me pause as to what the “qualified” criteria might be and how a person might be used to be either over- or under-enthusiastic in performing the examination, depending on political objectives. I would prefer both the qualifications and the selection of the persons be established independent of the department and validated as not political in nature. (B)(3) uses the term “incubation period.” This brings in question the organization of this section. The phrase in (A)(2), “exposed to the contagious disease for which the public health emergency has been declared” might better be by itself at the beginning of the section, so that “incubation period” would be qualified by this phrase; otherwise, what “incubation period?”)

Vaccinations and Treatments

Section 44-4-520. Vaccinations and treatment

(A) For purposes of this section, “informed consent” means a written document that is signed and dated by an individual; or, if the individual is a minor, by a parent or legal guardian; or, if the individual is incapacitated or without sufficient mental capacity, by a designated health care agent pursuant to a health care power of attorney, that at a minimum includes:

(1) an explanation of the vaccine or treatment that is written in language that is understandable to the average lay person;

(2) a description of the potential risks and benefits resulting from vaccine or treatment, along with a realistic description of the most likely outcome;

(3) a statement acknowledging risks associated with the vaccine or treatment if the vaccine or treatment is an indemnified product as defined in Section 44-1-55(A)(7); and

(4) language that clearly indicates that the individual agrees to the administration of the vaccine or treatment, that the individual has had time to thoughtfully and voluntarily accept or decline the vaccine or treatment free from coercion.

(B) During a state of public health emergency, the department may exercise the following emergency powers, in addition to its existing powers, over persons as necessary to address the public health emergency:

(1) to vaccinate persons as protection against infectious disease and to prevent the spread of contagious or possibly contagious disease;

(2) to treat persons exposed to or infected with disease; and

(3) to prevent the spread of contagious or possibly contagious disease, may isolate or quarantine, pursuant to the applicable sections of this act, symptomatic persons or persons exposed to the disease who are unable or unwilling for any reason (including, but not limited to, health, religion, or conscience) to undergo vaccination or treatment pursuant to this section.

(C) Vaccinations or treatment, or both, must may be provided only to those individuals who agree provide informed consent to receive the vaccinations or treatment, or both.

(D)

(1) Vaccination Vaccinations may be performed by any qualified person authorized by the department.

(2) To be administered pursuant to this section, a vaccine must not be such as is reasonably likely to lead to serious harm to the affected individual.

(E)

(1) Treatment must be administered by any qualified person authorized to do so by the department.

(2) Treatment must not be such as is reasonably likely to lead to serious harm to the affected individual

(F) The safety and efficacy of vaccines, tests, and treatments performed and administered as provided in this section must be reviewed and adverse events monitored by the department. References to evidence-based data determined to validate vaccines, tests, and treatments including, but not limited to, VAERS data must be prominently posted on the department’s public website.

(Notes: The removal of “possibly contagious” from the text is a good move. The description of informed consent is in need of a framework. (A) I have worked on both adult and parent informed consent frameworks, and they are very different. In my opinion, the definition here is not adequate. The only reason I can think of is that this entire bill is partly implicitly and partly explicitly not dealing with children (“minor”). However, it is confusing vaccination with the general treatment of infectious disease. This needs work! (B) “power” over persons? This seems like poor phrasing. (D)(1) Qualified person issue again. It seems like who picks and what they are qualified to do needs to be handled in the definitions section. It needs to be tied to “Health Care Professional?” )

Isolation and quarantine of individuals or groups; penalty for noncompliance.

SECTION 44-4-530.Isolation and quarantine of individuals or groups; penalty for noncompliance.

(A) During a public health emergency, the department may isolate or quarantine an individual or groups of individuals who have been diagnosed with or exposed to the contagious disease for which the public health emergency was declared. This includes individuals or groups who have not been vaccinated, treated, tested, or examined pursuant to Sections 44-4-510 and 44-4-520. The department may also establish and maintain places of isolation and quarantine, and set rules and make orders.

(B) The department must adhere to the following conditions and principles when isolating or quarantining individuals or groups of individuals:

(1) isolation and quarantine must be by the least restrictive means necessary to prevent the spread transmission of a contagious or possibly contagious disease to others and may include, but are not limited to, confinement to private homes or other private and public premises;

(2) individuals isolated because of objective evidence of infection or contagious disease must be confined separately from quarantined asymptomatic individuals;

(3) the health status of isolated and quarantined individuals must be monitored regularly to determine if they require isolation or quarantine;

(4) an asymptomatic quarantined individual must be confined for no more than twenty-one days;

(5) if a quarantined individual becomes infected or is reasonably believed to be infected with a contagious or possibly contagious disease, then he or she must be promptly removed to isolation;

(6) isolated and quarantined individuals must be immediately released when they no longer pose no substantial risk of transmitting a contagious or possibly contagious disease to others;

(7) the needs of persons isolated and quarantined must be addressed in a systematic and competent fashion including, but not limited to, providing adequate food, clothing, shelter, means of communication with those in isolation or quarantine and outside these settings, medication, and competent medical care;

(8) premises used for isolation and quarantine must be maintained in a safe and hygienic manner and be designed to minimize the likelihood of further transmission of infection or other harms to persons isolated or quarantined; and

(9) to the extent possible, cultural and religious beliefs must be considered in addressing the needs of the individuals and establishing and maintaining isolation and quarantine premises.; and

(10) individuals who have recovered from the contagious disease must not be involuntarily separated from quarantined or isolated family members.

(C) A person subject to isolation or quarantine must comply with 's the department’s rules and orders, and must not go beyond the isolation or quarantine premises. Failure to comply with these rules and orders constitutes a felony misdemeanor and, upon conviction, a person must be fined not more than one thousand two hundred dollars or imprisoned not more than thirty days, or both.

(D)(1) The department may authorize physicians, health care workers, or others access to individuals in isolation or quarantine as necessary to meet the needs of isolated or quarantined individuals.

(2) No person, other than a person authorized by , shall enter isolation or quarantine premises. Failure to comply with this provision constitutes a felony and, upon conviction, a person must be fined not more than one thousand dollars or imprisoned not more than thirty days, or both.

(2) A person entering an isolation or quarantine premises with or without authorization of the department may be isolated or quarantined as provided for in this chapter.

(3) The public safety authority and other law enforcement officers may arrest, isolate, or quarantine an individual who is acting in violation of an isolation or quarantine order after the order is given to the individual pursuant to Section 44-4-540(B)(3) or after the individual is provided notice of the order. In a case where an individual is not the subject of an isolation or quarantine order under Section 44-4-540, law enforcement officers may provide written or verbal notice of the order. Law enforcement officers may arrest, isolate, or quarantine an individual who is acting in violation of isolation or quarantine rules orders after the rules orders are established and the individual is given written or verbal notice of the rules orders. An arrest warrant or an additional isolation or quarantine order is not required for arrest, isolation, or quarantine under Section 44-4-530(D)(4)(3).

(E) An employer may not fire, demote, or otherwise discriminate against an employee complying with an isolation or quarantine order issued pursuant to Section 44-1-80, 44-1-110, 44-1-140, 44-4-520, 44-4-530, or 44-4-540; however, nothing in this section prohibits an employer from requiring an employee to use annual or sick leave to comply with such an order.

(Note: Again, the removal of “possibly contageous” is a good move. (A) The changes made were good. The last sentence: “set rules and make orders.” What does that mean? This needs qualification or a review process independent of the department. Will this be reviewed during the emergency order review process defined in Section 44-4-540? (B)(4) Regarding confinement for 21 days: This was discussed during the April 3 Medical Affairs meeting. The number was there because no one knew of a disease that would take more than 21 days before symptoms were present. Earlier in the bill the phrase “incubation period” was used. It seems to me that the same term can be used, qualified to the disease related to the public health emergency specification. I would use that term. However, this entire concept of confinement is a question mark. Those with Covid-19 or even those who have been innoculated, are known to shed infectious products. The disease itself can be, more or less, asymptomatic… until much later when one of the adverse effects shows up in the victim. I won’t reference the medical literature here for details, but the point is that infectious disease management requires a different management paradigm than the one invented, perhaps pre-historically, to manage infectious disease. LNP technology coupled with “gene therapy” has changed history forever.)

Isolation and quarantine procedures; order to show cause for not releasing.

Section 44-4-540: Isolation and quarantine procedures; order to show cause for not releasing.

This section’s topic is the filing of a petition to a trial court for an order authorizing the isolation or quarantine of an individual or groups of individuals. There aren’t many changes in S.54. The original language begins by giving the department the “may” to issue an emergency order. Within five (original was 10) days the department must file a petition for a court order “authorizing the continued isolation or quarantine of the isolated or quarantined individual or groups of individuals.” Lists of what the order and the petition must contain are given in the section. A hearing must be held within 5 days. The required contents of the court’s order is defined. There’s a bunch of other stuff on what-ifs each side does this or that. In S.54 there are some paragraphs that are stricken from the original, but I don’t have any comments about those. The whole idea of quarantine for disease is stupid unnecessary and, as I said, should be the purview of the attending healthcare provider.

The final section in S.54 is Section 44-4-570 and there is one change worth highlighting:

SECTION 44-4-570.Emergency powers regarding licensing of health personnel; appointment of in-state and out-of-state providers; liability of appointed providers for civil damages; appointment of emergency medical examiners or coroners; waiver of licensing fees and requirements; immunity.

(A) The department, in coordination with the appropriate licensing authority and the Department of Labor, Licensing and Regulation, may exercise, for such period as the state of public health emergency exists, in addition to existing emergency powers, the following emergency powers regarding licensing of health personnel:

(1) to require in-state health care providers to assist in the performance of vaccination, treatment, examination, or testing of any individual as a condition of licensure, authorization, or the ability to continue to function as a health care provider in this State;

(Note: Striking (1) is necessary to the success of S.54)

(Note: At the April 3 meeting there were some minor changes to the bill not reflected in the online version of the bill. Rather than adding the changes, I will await the publication of those changes and reedit this post.)

Overall, this appears to be the best bill we can hope to pass given the current makeup of the supermajority Republican legislature and the apparently uninterested governor. Again, many posts in this substack cover what a comprehensive public health reform bill for infectious disease should be.

1. I haven’t seen “comprehensive” informed consent frameworks with respect to infectious disease management. I do know, as something of an EMR expert, that EMR workflows can be considered frameworks. However, I don’t see frameworks reflected in public health legislation, though this bill has the beginning of one. I do have a good article on “guidelines” for informed consent that could be restructured as a framework: https://aihcp.net/2024/10/14/health-care-ethics-and-informed-consent-a-comprehensive-guide/

To complete this note, this is a brief overview of the framework concept as used in manufacturing. I got it from Grok, but I think it does a good job of summarizing the concept.

1. Purpose and Objectives:
   A framework starts with a clear definition of its purpose—why it exists and what it aims to achieve. In manufacturing or business, this could be improving productivity, reducing costs, ensuring quality, or streamlining operations. The objectives provide direction and measurable outcomes.

2. Structure and Components:
   It includes a well-defined structure that outlines the key components or stages of the process. For example, in manufacturing, this might involve steps like procurement, production, quality control, and distribution. In business, it could include planning, execution, monitoring, and review.

3. Processes and Workflows:
   A framework details the specific processes or workflows involved, including how tasks are sequenced, who is responsible, and how inputs are transformed into outputs. This ensures repeatability and clarity in execution.

4. Roles and Responsibilities:
   It assigns clear roles and responsibilities to individuals or teams, ensuring accountability and coordination. For instance, a framework might specify who oversees production schedules or who handles customer feedback.

5. Standards and Guidelines:
   A framework incorporates standards, policies, or best practices to maintain consistency and quality. In manufacturing, this might include compliance with ISO standards or safety regulations; in business, it could involve financial reporting guidelines.

6. Tools and Resources:
   It identifies the tools, technologies, or resources needed to support the process. This could range from software for project management to machinery in a factory setting.

7. Performance Metrics:
   Key performance indicators (KPIs) or metrics are embedded in the framework to evaluate success and identify areas for improvement. Examples include cycle time, defect rates, or customer satisfaction scores.

8. Flexibility and Adaptability:
   While providing structure, a good framework allows for adaptability to accommodate changes, such as shifts in market demand, new technologies, or unforeseen disruptions.

9. Feedback and Continuous Improvement:
   It includes mechanisms for gathering feedback and refining the process over time. This could involve regular reviews, audits, or iterative updates based on data and outcomes.

10. Alignment with Goals:
    The framework ensures alignment with broader organizational goals, whether that’s profitability, sustainability, or customer satisfaction, tying individual processes to the bigger picture.

In essence, a framework in manufacturing or business is a holistic system that balances structure with flexibility, enabling teams to work efficiently while adapting to challenges. It’s like the scaffolding that supports a building—providing stability and shape while allowing room for growth and refinement.

Documents Supporting the bill:

S54 Resolutions Newsarticle

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