special reports
States Actively Address Bioterrorism
Matthew Schulze
State and Professional Affairs, American Society for Clinical Pathology
Even though most state legislatures had adjourned for the
year by the time of the September 11th attacks on the World
Trade Center and the Pentagon, these attacks as well as the
numerous reports of anthrax have prompted a flurry of state
legislative and regulatory proposals, many of which are aimed
at addressing bioterrorism. Since the September 11th attacks
there have been more than 500 bills introduced that pertain to
bioterrorism, biological agents, or terrorism. The bills range in
focus from improving state and local preparedness efforts to
increasing criminal penalties. The state regulatory agencies
have also been proposing or implementing regulations to deal
with terrorism. This special report provides a sample of the
state initiatives concerning bioterrorism.
One of the more eye-catching proposals concerns the establishment of “emergency health powers.” The legislatures of Illinois, Massachusetts, Minnesota, Missouri, and New York are
considering legislation to increase each state’s authority to deal
with bioterrorism and other potential public health crises. These
measures have been introduced to facilitate the early detection
and abatement of a health emergency, and to allow immediate
investigation of such an emergency by granting access to individuals’ health information under certain circumstances.
The legislator who introduced the first emergency health
powers measure was Illinois Senator Lisa Madigan (D-Cook),
who brought forward SB 1529 on November 13, 2001. It allows the Governor to declare a public health emergency if
there is an occurrence or there is a threat of an illness or
health condition, caused by bioterrorism, epidemic or pandemic disease, or by a highly fatal infectious agent or biological toxin, that poses a risk of a significant number of human
fatalities or incidents of disability.
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The measure provides special powers for the control of persons (including mandated medical exams, laboratory tests, and
access to patient records). Refusal to submit to such an examination or test could result in the individual being quarantined or
charged with a misdemeanor. The other measures were
introduced by Massachusetts State Senator Richard T. Moore
(D-Worchester), who introduced SB 1294; New York State Senators Kemp Hannon (R-Nassau) and James L. Seward (RChanango), who together introduced SB 584; New York
Assemblymember Ronald J. Canestrari (D-Albany), who introduced AB 9508; Minnesota Representative Thomas Huntley (DSt. Louis), who introduced HB 2619; and Missouri State Senator
Marvin A. Singleton (R-Jasper), who introduced SB 712.
Other initiatives include an executive order issued by
Iowa Governor Thomas J. Vilsack on October 23, 2001, ordering Iowa National Guard troops to be posted at certain
Iowa laboratories. The order applies only to those Iowa laboratories that possess sufficient stocks of biological agents that
could be utilized for a widespread biological attack. National
guard troops shall remain posted at these facilities until the
Iowa Department of Emergency Management has approved
each laboratory’s security protocol.
On November 2, 2001, Florida Governor Jeb Bush announced that the Florida Department of Health has received
$500 000 from the United States Department of Health and
Human Services to be used to assist in the surveillance, detection, and confirmation of possible incidents of bioterrorism. The funding will supplement $3 million, to be used over
the next 3 years, from the Centers for Disease Control and
Prevention’s Public Health Preparedness and Response for
Bioterrorism grant to that state.
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Another Florida initiative includes a bill introduced by
State House of Representatives Majority Leader Representative
Mike Fasano (R-Hernando) on October 19, 2001, requiring
certain health care practitioners to receive instruction on conditions caused by bioterrorism and to receive training in basic or
advanced life support. This requirement would affect pathologists and other physicians but would not impact non-physician
laboratory personnel. This requirement is provided in lieu of
the state requirement for instruction in HIV/AIDS. The measure, HB 19B, also requires the Department of Health to ask on
its licensure and certification forms if the practitioner would be
available to provide disaster medical assistance. Representative
Fasano’s bill is intended to better educate health care providers
on the diseases and conditions that might be caused by bioterrorism so that health care practitioners can more effectively
educate their patients about prevention and treatment. Representative Fasano’s measure is similar to an emergency rule that
was adopted by the State Department of Health on October 26,
2001, that allows physicians to substitute continuing medical
education in nuclear, biological, or chemical terrorism for the
state’s continuing education requirement in HIV/AIDS, domestic violence, or end-of-life care.
In North Carolina, Governor Michael F. Easley (D) signed
into law a measure establishing a state biological agents registry. State Representative William T. Culpepper III (DChowan) introduced the measure on October 30, 2001.
Culpepper’s bill requires all individuals, laboratories, medical
and research facilities, and other entities possessing biological
agents that may be or may be engineered to be capable of
causing death or disease to report this information to the state
department of health and human services. The measure also
establishes a system of safeguards to be followed by laboratories and medical and research facilities to alert authorities in
the event of unauthorized possession or attempted possession
of biological agents. In addition, Governor Easley signed into
law a measure (HB 1471) appropriating $31.9 million to implement terrorism defense measures in North Carolina.
California Governor Gray Davis issued executive order
47 on October 11, 2001, ordering the state committee on terrorism to evaluate the potential threat of terrorist attack, review California’s readiness to prevent and respond to a
potential attack, and establish and prioritize recommendations
for prevention and response. The order also directs the committee to consider facilities that manufacture, process, transport, dispose of, or store dangerous substances.
Also in California, the California Department of Health
Services released on November 16, 2001, a notice of
emergency rulemaking on disease reporting to assess potential
bioterrorism events. The emergency rule amends the state’s list
of reportable diseases and conditions to deal with the growing
threat of bioterrorism. The rule would add smallpox (variola)
and varicella (deaths only) to the list of diseases that must be
reported by the health care provider to the local health officer.
In addition, the rule requires that laboratory findings that may
be indicative of anthrax, botulism, brucellosis, smallpox (vari-
ola), tularemia, and viral hemorrhagic fever agents (eg,
Crimean-Congo, Ebola, Lassa, and Marburg viruses) be
reported within 1 hour of the laboratory notifying the health
care provider. Similar rules have been proposed or implemented
in numerous other states, including Alabama, Colorado,
Delaware, Louisiana, New York, and Oregon, to name a few.
On September 28, 2001, Louisiana Governor M.J.
“Mike” Foster, Jr. issued Executive Order 48, requiring that
certain state emergency personnel be properly equipped and
prepared to respond to incidents of domestic terrorism involving chemical and biological agents as well as radiological,
nuclear, and explosive devices.
New York State Senator Serphin R. Maltese (R-Queens)
introduced SB 5812 on October 17, 2001, to make it a crime to
mail a substance that is intended to appear to be a biological or
chemical weapon. Also in New York, Senator Michael A.L. Balboni (R-Nassau) et al introduced SB 5823 on October 24, 2001.
His measure establishes several crimes relating to chemical and
biological weapons. It would create the crimes of criminal possession of a chemical or biological weapon in the 1st and 2nd
degrees and criminal use of a chemical or biological weapon in
the 1st and 2nd degrees. In North Carolina, a similar measure
was signed into law by Governor Easley (SB 1468) on November 28, 2001, to provide criminal penalties for unlawful manufacture, possession, sale, delivery, acquisition, or use of a
biological, chemical, or radiological weapon on mass destruction. The measure, introduced by North Carolina House of Representative Majority Leader Philip A. Baddour, Jr. (D-Lenoir) et
al, also makes it a crime to make a false report or stage a hoax
about such a weapon of mass destruction.
In Kentucky, State Representative Tom J. Burch (D-Jefferson) introduced HB 914, which requires the state to assess its
preparedness to handle acts of terrorism involving chemical or
biological agents. Representative Burch’s bill requires the commissioner of the department of public health, in conjunction with
other state agencies, local agencies, and local health care
providers to assess the readiness of laboratories across the state
to respond to acts of terrorism involving biological or chemical
agents as well as the adequacy of state health reporting requirements for certain illnesses or conditions. The measure also requires the state to study the educational needs of the health care
work force relating to chemical or biological agents and the adequacy of communication networks for receiving and broadcasting health alerts. Similarly, Wisconsin Assemblyman Marlin D.
Schneider (D-Adams) et al introduced AJR 62 on October 8,
2001. The measure requests the legislative council to conduct a
study of terrorism and methods to counter acts of terrorism.
These are but a few of the legislative and regulatory initiatives that states have been working on since the September
11th attacks. More are sure to follow, as the states increase
their attention to mitigate any future acts of terrorism. The
ASCP Washington Office will be following these issues carefully to ensure that pathologists and laboratory professionals
are kept abreast of any policy changes that may affect the
practice of laboratory medicine.
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