This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h1487.HRS
DATE: 4/4/2023
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 1487 Declarations of a Public Health Emergency
SPONSOR(S): Healthcare Regulation Subcommittee, Rudman and others
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY
CHIEF
1) Healthcare Regulation Subcommittee 13 Y, 4 N, As CS McElroy McElroy
2) Constitutional Rights, Rule of Law &
Government Operations Subcommittee
3) Health & Human Services Committee
SUMMARY ANALYSIS
The Department of Health (DOH) is established under s. 20.43, F.S., to “protect and promote the health of all
residents and visitors in the state through organized state and community efforts, including cooperative
agreements with counties”. The head of the Department of Health is the Surgeon General, also designated the
State Health Officer.
Current law authorizes the State Health Officer to declare a public health emergency and establishes
requirements for such situations. The law limits public health emergencies to natural or manmade occurrences
that result or may result in substantial injury or harm to the public health from infectious disease, chemical
agents, nuclear agents, biological toxins, or situations involving mass casualties or natural disasters. Before
declaring a public health emergency, the State Health Officer must, to the extent possible, consult with the
Governor and notify the Chief of Domestic Security. A public health emergency may not continue longer than
60 days unless the Governor concurs in the renewal of the declaration.
The State Health Officer is also authorized to order an individual to be examined, tested, treated, isolated, or
quarantined during a declared public health emergency. In particular, current law authorizes the State Health
Officer to order an individual to isolate or quarantine if the individual is unable or unwilling to be examined,
tested or treated. If there is no practical method to isolate or quarantine, the State Health Officer may use any
means necessary to vaccinate or treat an individual. Any such order issued by the State Health Officer is
enforceable by a law enforcement officer, including any sheriff, deputy or police officer.
PCS for HB 1487 revises the Governor’s authority to renew a declaration of a public health emergency. The
Governor may renew a statewide declaration of a public health emergency for 30 days without the approval of
the Legislature. Any subsequent renewal is valid for 60 days and requires approval by two-thirds vote of each
chamber of the Legislature. The Governor may renew public health declarations that are not statewide without
the approval of the Legislature. Any such renewal is valid for 60 days.
The bill authorizes an individual to refuse examination, testing or treatment for reasons of health, religion or
conscience by submitting a refusal in writing to the State Health Officer. Such individuals may be subjected to
isolation or quarantine. This is consistent with current law which allows for isolation or quarantine for an
individual who is unable or unwilling to undergo testing or treatment. The bill also clarifies that any treatment
that the State Health Officer may order a person to undergo does not include the administration of
vaccinations.
The bill has an indeterminate, significant, negative fiscal impact on the legislative branch. The bill has no fiscal
impact on local governments.
The bill provides an effective date of July 1, 2023. STORAGE NAME: h1487.HRS PAGE: 2
DATE: 4/4/2023
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Department of Health
The Department of Health (DOH) is established under s. 20.43, F.S., to “protect and promote the health
of all residents and visitors in the state through organized state and community efforts, including
cooperative agreements with counties”. The head of the Department of Health is the Surgeon General,
also designated the State Health Officer.
1
DOH regulates over 200 health practitioner license types, including more than 1.4 million health care
practitioners in 42 professions and 10 types of facilities.
2
DOH administers the Children’s Medical
Services safety net health care program, provides health care services in county health departments,
and regulates environmental activities that affect public health.
3
DOH also administers state
epidemiology functions, and is required to identify, diagnose, and conduct surveillance of diseases and
health conditions in the state and accumulate the health statistics necessary to establish trends. As part
of those functions, DOH maintains vital statistics and other health data, including vaccination
information.
Finally, current law requires DOH to coordinate preparedness for and responses to public health
emergencies.
4
Communicable Disease Prevention and Control
Current law requires DOH to conduct a communicable disease prevention and control program as part
of fulfilling its public health mission.
5
The communicable disease program must include, but is not
limited to, programs for the:
6
Prevention and control of tuberculosis;
Prevention and control of HIV and AIDS;
Prevention, control, and reporting of communicable diseases of public health significance
7
; and
Prevention and control of vaccine-preventable diseases, including programs to immunize school
children.
Current law authorizes DOH to declare, enforce, modify, and abolish the isolation and quarantine of
persons and premises as necessary to control communicable diseases or provide protection from
unsafe conditions that pose a threat to public health.
8
Any such order issued by DOH must be
immediately enforceable by a law enforcement officer, including any sheriff, deputy or police officer.
9
Public Health Emergencies
1
S. 20.43, F.S.
2
Correspondence from DOH to the Florida House of Representatives’ Professions and Public Health Subcommittee, dated November
9, 2021, on file with the subcommittee.
3
County Health Departments, Florida Department of Health, available at http://www.floridahealth.gov/programs-and-services/county-
health-departments/index.html (last visited on March 31, 2023).
4
S. 20.43, F.S.
5
S. 381.003, F.S. A communicable disease is any disease caused by transmission of a specific infectious agent, or its toxic products,
from an infected person, an infected animal, or the environment to a susceptible host, either directly or indirectly.
6
S. 381.003, F.S.
7
S. 381.0031, F.S., authorizes DOH to conduct epidemiological studies of diseases of public health significance and requires health
care practitioners and facilities to immediately report any known or suspected cases of such diseases to DOH.
8
S. 381.00315, F.S. (2021)
9
Id. STORAGE NAME: h1487.HRS PAGE: 3
DATE: 4/4/2023
Under emergency conditions, the usual methods of disease prevention are inadequate and require
short-term expansion of authority. Similar to the governor’s authority to declare emergencies under
chapter 252, emergency authority is available for emergencies of a public health nature. Current law
makes the State Health Officer exclusively responsible for declaring public health emergencies, issuing
public health advisories and ordering isolation and quarantines.
10
This responsibility, and the authority
associated with it, has changed periodically in response to public health emergencies encountered on
state and national levels.
Prior to 2002, the State Health Officer had broad discretion, with limited statutory guidance, for issuing
public health advisories and declaring public health emergencies. No statutory guidance was provided
for public health emergencies, thereby granting exceptionally broad discretion to the State Health
Officer.
Prior to 2002, ordering an individual to quarantine was an ordinary duty of DOH. Florida law expressly
authorized DOH to declare, enforce, modify and abolish quarantine of individuals.
11
The authority was
not dependent upon a declared public health emergency; rather, this was a standard function of
communicable disease control. At that time, Florida law did not expressly authorize DOH to order an
individual to be vaccinated.
The events of 9/11 and a 2001 anthrax outbreak
12
in Florida prompted the legislature to evaluate its
preparedness for public health emergencies. In response, Florida enacted omnibus public emergency
legislation in 2002. The legislation empowered the State Health Officer to take additional steps to
protect public health during a public health emergency and remains in place today.
Section 381.00315, F.S., grants the State Health Officer (rather than DOH in general) the authority to
declare a public health emergency, and establishes requirements for such situations. The law limits
public health emergencies to natural or manmade occurrences that result or may result in substantial
injury or harm to the public health from infectious disease, chemical agents, nuclear agents, biological
toxins, or situations involving mass casualties or natural disasters.
13
Before declaring a public health
emergency, the State Health Officer must, to the extent possible, consult with the Governor and notify
the Chief of Domestic Security.
14
A public health emergency may not continue longer than 60 days
unless the Governor concurs in the renewal of the declaration.
15
Current law also authorizes the State Health Officer to take certain actions to protect public health
during a declared public health emergency, including, but not limited to:
16
Directing manufacturers of prescription drugs or over-the-counter drugs to give priority shipping
of specified drugs to certain pharmacies and hospitals;
Directing pharmacies to compound bulk prescription drugs; and
Temporarily reactivating inactive licenses of certain healthcare professionals.
For example, the Surgeon General has declared public health emergencies for statewide epidemics,
hurricanes and localized outbreaks, among others. For example, in 2017, the Surgeon General
declared a public health emergency related to the statewide opioid epidemic. As part of that
declaration, the Surgeon General issued a standing order for naloxone
17
, which allowed law
10
Id.
11
S. 381.001, F.S. (2001).
12
Letters containing anthrax were mailed to media personnel and congressional officials in several states, including Florida. This
resulted in 22 people falling ill from exposure to anthrax, 5 of whom ultimately died. Bioterrorism - Public Health Response to Anthrax
Incidents of 2001, United States General Accounting Office, October 2003, available at https://www.gao.gov/assets/gao-04-152.pdf
(last visited on March 31, 2023).
13
S. 381.00315, F.S. (2021)
14
Id. The Chief of Domestic Security is the executive director of the Department of Law Enforcement, or his designee. Section
943.0311, F.S.
15
S. 381.00315, F.S. (2021)
16
Id.
17
Naloxone is an opioid antagonist that rapidly reverses an opioid overdose. Naloxone Drug Facts, National Institute of Drug Abuse,
available at https://www.drugabuse.gov/publications/drugfacts/naloxone (last visited on March 31, 2023). STORAGE NAME: h1487.HRS PAGE: 4
DATE: 4/4/2023
enforcement and EMS personnel to obtain this potentially life-saving drug without a prescription.
18
In
2018, in response to Hurricane Michael, the Surgeon General issued a declaration that waived
licensure requirements to allow licensed out-of-state practitioners to provide health care services in
Florida and waived certain regulations related to the dispensing of prescription medication.
19
In 2019,
the Surgeon General declared a public health emergency related to a Hepatitis A outbreak in several
counties.
20
The declaration sought assistance from the Centers for Disease Control and Prevention,
provided guidance to health care practitioners for screening and vaccinating individuals at high risk of
contracting Hepatitis A and provided advice for the cleaning and sanitizing of public restrooms.
21
In
March 2020, the Surgeon General declared a state of emergency related to the COVID-19 outbreak.
The Governor renewed the declaration every 60 days ultimately allowing the declaration to expire on
June 26, 2021.
22
The State Health Officer is also authorized to order an individual to be examined, tested, treated,
isolated, or quarantined during a declared public health emergency. In particular, current law authorizes
the State Health Officer to order an individual to isolate or quarantine if the individual is unable or
unwilling to be examined, tested, or treated. If there is no practical method to isolate or quarantine, the
State Health Officer may use any means necessary to treat an individual. Any such order issued by the
State Health Officer is enforceable by a law enforcement officer, including any sheriff, deputy or police
officer.
23
DOH is required to adopt rules for the conditions and procedures for imposing and releasing an
individual from an isolation or a quarantine, which must include provisions related to:
24
The movement of persons exposed to or infected with a communicable disease;
The tests or treatment, including vaccination, for communicable disease required before
employment or admission to the premises or to comply with an isolation or a quarantine;
Access by the department to isolated or quarantined premises;
The disinfection of isolated or quarantined persons; and
Methods of isolation or quarantine.
In 2006, DOH adopted rules required by the statute which authorized the State Health Officer, the
county health department director or their designee to:
25
Initiate or terminate conditions of quarantine.
Order an individual to quarantine, including requiring immunization as part of preventative
treatment;
Allow an individual to quarantine in their domicile unless the domicile is not a practical method
of quarantine; and
Access any quarantined premises.
Effect of the Bill
18
Amended Department of Health Declaration of Public Health Emergency and Standing Order for Naloxone, available at
http://www.floridahealth.gov/_documents/newsroom/press-releases/2017/05/050317-health-emergency-opioid-epidemic.pdf (last visited
on March 31, 2023).
19
Department of Health Emergency Order, available at http://www.floridahealth.gov/_documents/newsroom/press-
releases/2018/10/100818-fdoh-emergency-order-michael.pdf (last visited on March 31, 2023).
20
Department of Health Declaration of Public Health Emergency, available at
http://www.floridahealth.gov/_documents/newsroom/press-releases/2019/08/phe-hav-filed-08-01-2019.pdf (last visited on November 9,
2021). The counties at issue were Brevard, Citrus, Glades, Hernando, Hillsborough, Lake, Liberty, Manatee, Marion, Martin,
Okeechobee, Orange, Pasco, Pinellas, Sumter, Taylor and Volusia.
21
Department of Health Declaration of Public Health Emergency, available at
http://www.floridahealth.gov/_documents/newsroom/press-releases/2019/08/phe-hav-filed-08-01-2019.pdf (last visited on March 31,
2023).
22
The Governor issued Executive Order Number 21-94 on April 27, 2021, thereby extending the state of emergency until June 26,
2021. https://www.flgov.com/wp-content/uploads/orders/2021/EO_21-94.pdf (last visited on March 31, 2023).
23
S. 381.00315, F.S. (2021)
24
Id.
25
Rules 64D-3.037 and 64D-3.037 F.A.C. STORAGE NAME: h1487.HRS PAGE: 5
DATE: 4/4/2023
PCS for HB 1487 revises the Governor’s authority to renew a declaration of a public health emergency.
The Governor may renew a statewide declaration of a public health emergency for 30 days without the
approval of the Legislature. Any subsequent renewal is valid for 60 days and requires approval by two-
thirds vote of each chamber of the Legislature. The Governor may renew public health declarations that
are not statewide without the approval of the Legislature. Any such renewal is valid for 60 days.
The bill authorizes an individual to refuse examination, testing or treatment for reasons of health,
religion or conscience by submitting a refusal in writing to the State Health Officer. Such individuals
may be subjected to isolation or quarantine. This is consistent with current law that allows for isolation
or quarantine for an individual who is unable or unwilling to undergo testing or treatment. The bill also
clarifies that any treatment that the State Health Officer may order a person to undergo does not
include the administration of vaccinations.
The bill provides an effective date of July 1, 2023.
B. SECTION DIRECTORY:
Section 1: Amends s. 381.00315, F.S., relating to public health advisories, public health emergencies
and isolation and quarantines.
Section 2: Provides an effective date of July 1, 2023.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
The bill has an indeterminate, significant, negative fiscal impact on the legislative branch related to
costs associated with the special sessions required to approve renewal of a statewide declared
public health emergency. In recent years, the average daily cost for special sessions scheduled
when the Legislature was not already meeting ranged from $45,000-$57,000 per day.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision: STORAGE NAME: h1487.HRS PAGE: 6
DATE: 4/4/2023
2. Other:
None.
B. RULE-MAKING AUTHORITY:
None.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES