On October 24, 2014, New Jersey governor Chris Christie announced that individuals who came into contact with Ebola patients in the West African countries of Liberia, Sierra Leone and Guinea would be subject to a mandatory 21-day quarantine upon entering New Jersey. As a result, an American nurse named Kaci Hickox was quarantined upon entering New Jersey at Newark Liberty International Airport. Hickox questioned the legality of her quarantine and retained an attorney to mount a legal challenge. This article will analyze the legality of medical quarantines, and specifically the medical quarantine announced in relation to Ebola in New Jersey.
The first place to start the analysis is to look at whether there is any applicable law that permits government in New Jersey to impose a medical quarantine. Under New Jersey Statute 26:4-2(d), “[i]n order to prevent the spread of disease affecting humans, the Department of Health , and the local boards of health within their respective jurisdictions and subject to the State sanitary code, shall have power to…[m]aintain and enforce proper and sufficient quarantine, wherever deemed necessary.” N.J.S. 26:4-2(d). Under New Jersey administrative regulations, “quarantine” is defined as “the physical separation and confinement of an individual or groups of individuals, who are or may have been exposed to a communicable or possibly communicable disease and who do not show signs or symptoms of a communicable disease, from unexposed individuals, to prevent or limit the transmission of the disease to unexposed individuals.” N.J.A.C. 8:57-1, Appendix B, § 1.2. According to Governor Christie, the decision to quarantine Hickox was purportedly made by the New Jersey Department of Health, presumably invoking its authority under N.J.S. 26:4-2(d). Given that the statute gives broad powers to the Department of Health, presumably they were acting within their statutory authority.
In spite of the broad power to quarantine granted by statute to the Department of Health, that governmental power is still subject to any restraints placed upon governmental authority by either the New Jersey state constitution or the federal constitution. The constitutional authority for states to enact quarantine laws comes from the “police powers” reserved by the states. Under the Tenth Amendment to the United States Constitution, “[t]he powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.” These powers that are reserved to the States, include the “police powers,” which provides the States with the power to pass laws, and coerce compliance with the laws, to further the health, safety, welfare, and morals of their citizens. Under the police powers, it is clear that the New Jersey legislature had the constitutional authority to pass legislation allowing for medical quarantines when they are required to protect the health and safety of citizens.
Nevertheless, the police powers, while very broad, are not unlimited. Under New Jersey law, in order for a quarantine to fall within the police powers, it must be substantially related to a governmental object, and must not be arbitrary and unreasonable and beyond the necessities of the case. Borden’s Condensed Milk Co. v. Board of Health of Town of Montclair, 81 N.J.L. 218, 228 (N.J. 1911). Under the relevant case law, in order for a quarantine to be deemed reasonable, there does not need to be agreement as to the necessity of the quarantine. Rather, the governmental agency that issued the quarantine must have relied on some medical authority declaring that the quarantine was necessary. This is where there are some troubling issues with respect to New Jersey’s Ebola quarantine.
It is unclear from publicly available sources what medical authority the State of New Jersey is relying on for determining the reasonableness and necessity of a medical quarantine. It appears that the New Jersey Department of Health relies on the Office of the State Epidemiologist in establishing its guidelines related to Ebola. If the State Epidemiologist, who is a medical doctor, issued an opinion to the Department of Health that a quarantine of any individual who came into contact with Ebola patients is medically reasonable, then the Ebola quarantine would be presumptively constitutional. However, the Centers for Disease Control and Prevention (CDC), upon which the New Jersey Department of Health relies heavily for information related to Ebola, has stated that hospital isolation, such as the one imposed by New Jersey on Hickox, is not required unless the individual displays symptoms of Ebola infection. Nevertheless, there is not universal agreement by all medical professionals that a quarantine is not medically reasonable for individuals exposed to Ebola patients, but not currently showing symptoms of Ebola. Therefore, it is likely that a Court would uphold New Jersey’s Ebola quarantine as statutorily and constitutionally authorized.