Ebola quarantine: why judge sided with nurse Kaci Hickox

A state judge in Maine has sided with nurse Kaci Hickox and rejected a request by state officials that her movements be restricted out of an abundance of caution over her recent exposure to the Ebola virus while treating patients in West Africa.

Chief District Court Judge Charles LaVerdiere had been asked to order Ms. Hickox to comply with the demands of state health officials, including banning her from public transportation, movie theaters, and crowded shopping areas.

In rejecting the request, the judge said in a four-page order issued on Friday that Hickox does not show any symptoms of Ebola and therefore is not infectious.

“The state has not met its burden at this time to prove by clear and convincing evidence that limiting [Hickox’s] movements to the degree requested is necessary to protect other individuals from the dangers of infection,” the judge wrote.

Judge LaVerdiere noted that Hickox had agreed to submit to active monitoring of her health by state health workers twice a day and that if her condition changes, “then it will become necessary to isolate [Hickox] from others to prevent the potential spread of this devastating disease.”

In his order, the judge instructed Hickox to continue to cooperate with ongoing active monitoring. He also ordered her to notify public health officials of any travel plans to facilitate uninterrupted monitoring. And he instructed her to immediately notify officials if any symptoms appear.

The judge’s ruling modifies an order issued on Thursday that imposed an array of restrictions on Hickox’s movements. The judge’s new order will remain in effect pending the outcome of a full hearing that must be held within the next 10 days.

Maine Gov. Paul LePage said the judge’s decision was “unfortunate” but that the state would abide by the ruling.

“My duty to protect the health of the individual, as well as the health and safety of 1.3 million Mainers, is my highest priority,” the governor said in a statement. “Despite our best effort to work collaboratively with this individual[,] she has refused to cooperate with us.”

The ruling for Hickox marks the latest twist in a growing national debate over the best way to prevent the possible spread of the Ebola virus within the United States.

Hickox maintains that public health officials were violating her rights and freedom with no legal justification. Maine health officials have countered that their actions were being taken out of an abundance of caution to protect the health and safety of the state’s entire population.

Last week in New York City, health officials had to retrace the movements of a doctor who had volunteered in West Africa and later tested positive for the Ebola virus.

The Centers for Disease Control and Prevention, as well as the Obama administration, has said that health-care workers returning from West Africa need not be subject to mandatory quarantine restrictions. Nonetheless, the administration is requiring all US military personnel returning from West Africa to remain in quarantine for 21 days.

Several states including New Jersey, New York, and Maine have sought to impose quarantine requirements on anyone exposed to Ebola – including returning health-care workers. During the past few days, Maine officials dropped their strict quarantine requirement, but have continued to push for significant restrictions on Hickox’s movements.

In rejecting those restrictions, LaVerdiere emphasized that Hickox had “generously, kindly, and with compassion lent her skills to aid, comfort, and care for individuals stricken with a terrible disease.”

He added: “We need to remember as we go through this matter that we owe [Hickox] and all professionals who give of themselves in this way a debt of gratitude.”

But the judge also offered advice to Hickox that she should to be sensitive to the widespread fear among members of the public. “Whether that fear is rational or not, it is present and it is real,” he said. “Respondent’s actions at this point, as a health care professional, need to demonstrate her full understanding of human nature and the real fear that exists.”

The judge said: “She should guide herself accordingly.”

In a filing with the judge, Sheila Pinette, director of the Maine Center for Disease Control and Prevention, said that in her professional opinion, “the conduct and circumstances ascribed to [Hickox] constitute a public health threat.”

Since her quarantine in New Jersey last weekend, Hickox has embraced a defiant posture when confronted by concerned health officials. After returning to Maine and being asked to stay home on Thursday, she took a morning bike ride with her boyfriend.

Dr. Pinette said in her filing to the judge that after Hickox had been released from quarantine in New Jersey, Maine officials sought to coordinate her trip home. Hickox replied by e-mail that she intended to spend a night or two in Freeport, Maine, before traveling home to Fort Kent.

That plan was apparently changed and Hickox, in fact, traveled to Fort Kent, according to court documents.

Pinette said that even though Hickox had tested negative for the Ebola virus last weekend, it didn’t mean she was disease-free. The monitoring period is 21 days.

“The surest way to minimize the public health threat is direct active monitoring and additional restrictions outlined below until the exposed person has passed the incubation period,” Pinette said. For Hickox, she said, that period would expire Nov. 10.

“It is my opinion that Hickox should be subjected to an appropriate public health order for mandatory direct active monitoring and restrictions on movement as soon as possible and until the end of the incubation period, Novemer 10, 2014 to protect the public health and safety,” Pinette said.

Hickox, a specialist in infectious diseases, traveled to Sierra Leone to work with the relief group Doctors Without Borders. During that time her roommate was diagnosed with the virus, despite taking full precautions.

Pinette said that any potential risk to Hickox from that case had already passed.