Maine nurse without symptoms won’t submit to Ebola quarantine, lawyer says

Posted at 10:36 AM, Oct 29, 2014
and last updated 2014-10-29 12:50:10-04

A nurse who was quarantined against her will in New Jersey after treating Ebola patients in West Africa will not obey officials’ instructions to seclude herself at home in Maine, she and her lawyers said on the “Today” show and in the Bangor Daily News.

Kaci Hickox

One of the nurse’s lawyers told CNN Wednesday that they are trying to work with Maine officials to avoid escalating the situation.

The nurse, Kaci Hickox, returned to Maine on Monday after New Jersey authorities released her from a hospital tent where state officials kept her over the weekend as part of a new quarantine policy. She hired a lawyer and spoke out about her isolation and was then transported to Maine.

She has twice tested negative for the virus.

Maine officials have said that they would ask Hickox to quarantine herself at home until the passage of 21 days from her last possible contact with an Ebola patient, adding that they would make it involuntary if she resisted.

“Today” show host Matt Lauer on Wednesday asked her if she planned to follow guidelines and finish that quarantine on November 10.

“I don’t plan on sticking to the guidelines,” she said. “I remain appalled by these home quarantine policies that have been forced upon me.”

That could set up a confrontation with Maine officials.

A fight ahead?

Maine officials are “exploring all of our options” to protect residents’ health, Gov. Paul LePage said Wednesday after Hickox declared she would resist a home quarantine. He did not name the nurse.

In a written statement, the governor said she “has been unwilling to follow the protocols set forth by the Maine CDC and the U.S. Centers for Disease Control for medical workers who have been in contact with Ebola patients.” The statement didn’t say which protocols she was resisting but added that LePage is seeking legal authority to enforce a quarantine.

CNN’s attempts to contact LePage’s office weren’t immediately successful.

LePage has said the state would work with Hickox on a plan to isolate her for the 21-day period.

One of Hickox’s lawyers, Norm Siegel, told Lauer that officials had until Thursday to adjust their approach, and if they tried to physically apprehend Hickox, her legal team would take the matter to court.

On Tuesday, the state’s health commissioner — without naming Hickox — warned that the state would force the quarantine if she didn’t isolate herself willingly.

“If an individual who came in direct contact with Ebola patients has returned to Maine and is not willing to avoid public contact and stay in their home voluntarily during the period they are at some risk, we will take additional measures and pursue appropriate authority to ensure they make no public contact,” Maine Department of Health and Human Services Commissioner Mary Mayhew told reporters Tuesday.

“I want to be sure everyone understands what quarantine means in this case,” Mayhew said. “Stating it plainly, what we are asking for is that individuals who had direct contact with Ebola patients stay in their home and avoid public contact until the 21 days for potential incubation has passed.”

On CNN, Hickox attorney Steven Hyman said he thinks the next step is up to Maine.

“We had been attempting to work with them to try to find some kind of compromise here, but that has not been possible,” he said. “And I saw from their news conference last night that they intend to try to seek an order. We have received no paper, so at this point she is not under any restriction other than her own voluntary staying in the house today.”

Hyman said that knowing for certain what could happen legally is unclear because “we’re treading in areas” in which “there’s not a whole lot of case law.”

However, he said, “Society has a right to protect itself from legitimate issues of public health, but it can’t do it based on what the (U.S.) Supreme Court calls fear.”

The lawyer referred to the opinion of Dr. Amesh A. Adalja who also discussed the Hickox case on CNN on Wednesday, weighing in as an independent medical expert. He specializes in infectious disease and is a member of the U.S. government’s National Disaster Medical System.

Adalja said the nurse is not contagious if she is not having symptoms, and even if she were symptomatic, she would have to somehow pass along her bodily fluids to other people to infect them.

He said he worried that some had “forgotten” established science about the virus.

Lawyer: Nurse will follow CDC guidelines

Siegel told the Bangor newspaper that Hickox would contest any court order. But she will abide by guidelines from the Centers for Disease Control and Prevention that say she should subject herself to monitoring, such as daily reporting of measured temperatures.

“The conditions that the state of Maine is now requiring Kaci to comply with are unconstitutional and illegal and there is no justification for the state of Maine to infringe on her liberty,” Siegel told the Daily News.

The nurse told “Today” that she’s in good health and does not have symptoms. A person must be symptomatic to be contagious if they have Ebola.

She said that she thinks it would be “reasonable,” in circumstances like hers, to self-monitor for symptoms but not be quarantined. Those are the steps that the organization Doctors Without Borders recommends. She spent time recently in Sierra Leone treating Ebola patients with the group.

Hickox initially was put in isolation Friday, after landing in New Jersey from Sierra Leone.

New Jersey and New York had just started requiring anyone who had contact with Ebola patients in West Africa to be quarantined for 21 days. New Jersey officials additionally said that screeners determined that she had a fever at the airport.

But Hickox, speaking to CNN over the weekend from her quarantine tent at the New Jersey hospital, said she never had a fever.

“They were using a forehead scanner, and I was distressed and a little bit upset, and so my cheeks were flushed,” she told CNN’s Candy Crowley.

Hickox said her temperature was later determined to be normal.

Dispute about quarantine policies

New Jersey Gov. Chris Christie said the state agreed to let her go to Maine after confirming she “was no longer symptomatic,” but he is unapologetic about New Jersey’s quarantine policy.

Hickox told “Today” that she witnessed “complete disorganization” at the airport in Newark and that New York and New Jersey’s policies are “not scientifically” or “constitutionally just.”

The policies, she says, will be a “big deterrent” for health care workers who want to go to West Africa to treat patients, because they won’t want to be quarantined when they return if, like her, they are asymptomatic.

“It’s already difficult for people to take time out of their lives to go and respond,” she said, though she definitely plans to go back because it’s a “privilege to help.”

Christie said he doesn’t plan to move “an inch” on New Jersey’s Ebola quarantine policy.

Campaigning Tuesday in Rhode Island for GOP gubernatorial nominee Allan Fung, the straight-talking Republican also hit back at criticism that the nurse wasn’t treated well enough, arguing that she even had Internet access and takeout food.

“Whatever,” he said, when pressed by reporters about a potential legal challenge. “Get in line. I’ve been sued lots of times before. Get in line. I’m happy to take it on.”

The debate about how to treat returning health care workers comes amid what officials say is the worst Ebola outbreak in history.

The World Health Organization reported Wednesday that there are more than 13,700 confirmed or suspected cases of Ebola — almost all in Guinea, Liberia and Sierra Leone. The United Nations’ health authority projected that deaths from the virus have exceeded 5,000.

And those are only the ones that authorities have been able to count. In a region where health care access and record-keeping are limited, the WHO says the death toll may be especially under-counted. Some ill people who are seen by physicians and counted as Ebola cases may not stay for treatment and die of the disease, and the record keepers won’t know to record their deaths.

The WHO has said that the mortality rate from the current outbreak, starting with the first death in December, is roughly 60% to 70%.