Legislative Authorities and
Ernest B. Abbott and Jeffrey H. Luk
Catastrophic disasters disrupt the health and medical system in a
variety of different ways. The event itself a hurricane or earthquake may cause physical damage to medical infrastructure
(e.g., hospitals, clinics, doctors offices, laboratories, pharmacies, and medical suppliers). The event can also disrupt electrical
power or communications capabilities such as Internet and computer services. A disaster can also create new requirements for
medical care by of people when buildings or other structures collapse. Similarly, a pandemic outbreak
of infectious disease, or widespread exposure to chemical, radiological, or biological contamination, can overwhelm medical
infrastructure and medical providers with the number of patients
requiring treatment. Finally, as demonstrated by the 2004 Indian
Ocean Tsunami, Hurricane Katrina in the United States (2005),
and more recently, in 2012, Hurricane Sandy on the east coast of
the United States, a disaster can force the evacuation of hundreds
of thousands of people who then become separated from their
regular medical care network (e.g., doctors, nurses, prescription medications, and medical records). These evacuees arrive
in relocation areas with medical systems unprepared to treat the
baseline health and medical needs of so many additional patients,
in addition to any traumatic and psychological conditions caused
by the disaster.
Catastrophic disasters also challenge the legal basis of the
health and medical system. Practitioners may be familiar with
legal and regulatory requirements applicable to the provision
of medical care in normal times, but in a disaster environment, compliance with some legal requirements becomes problematic. Are regulatory requirements relaxed or changed under
emergency conditions, or are practitioners left simply to do
the best they can and trust that regulators will choose not
to enforce standards? The this
In the United States, federal rules require clinicians to perform a medical screening examination and stabilization of
any patient who arrives on hospital grounds requesting medical care. How does this regulation apply when there is a
physical plant disruption such as a hospital flood or fire,
or a chemical, biological, or radiological contamination on
Virtually all sovereign governments ensure the competence
of medical professionals by issuing certificates or licenses to
those authorized to practice medicine within their respective
borders yet, in a disaster, medical volunteers and medical
providers from other jurisdictions will cross state or national
boundaries to treat disaster victims. Under what circumstances do their medical or other health professional licenses
allow them to treat casualties? Should they be concerned
about violating geographic restrictions contained in their
professional malpractice insurance policies?
Sovereign nations, and provincial and states within sovereign
nations, bestow on designated officials broad emergency
powers over healthcare and public health systems upon
some sort of designation or declaration of a state of emergency or disaster. Yet, exactly what those powers are, who
can exercise them, how timely they can be executed, and how
those and professionals providing
medical care can vary dramatically.
This chapter will review disaster legal issues primarily from the
perspective of persons or institutions including individual
doctors or nurses, medical practices, laboratories, clinics, and
hospitals who collectively provide medical care to patients in
the midst of a catastrophic disaster or other public health emergency. This chapter summarizes the key areas where the legal
environment of medical care may change as a result of disasters
and other catastrophic events. Some of these changes occur in
the specific requirements imposed on practitioners by national,
state/provincial and, in some cases, local governments and agencies. Providers must be alert to how those changed requirements
will be communicated to them.
Providers must also be familiar with how a disaster may
create exposure to economic penalties and liabilities where the
care provided in emergencies does not meet normal standards
of medical practice. This exposure may be experienced, after the
fact, through judicial award of on malpractice of medical providers. Providers must also be cognizant
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