Hickox v. Christie

The plaintiff, Kaci Hickox, brought a civil rights action against Governor Christie and state public health officials, alleging that her 80-hour quarantine, upon returning to the United States after caring for Ebola patients in West Africa, violated her rights under the Fourth and Fourteenth Amendments.

Prior to the plaintiff’s return to the United States, a statewide Ebola Preparedness Plan (EPP) was implemented, providing for active screening of passengers arriving from West African countries, and the possible quarantine of asymptomatic travelers, with high risk of exposure, at the discretion of the Department of Health (DOH).

When Kaci Hickox returned to the United States from Sierra Leone, West Africa, where she had worked as a nurse at an Ebola treatment unit, she was stopped after indicating she was arriving from Sierra Leone. She was transferred to the CDC Quarantine Station, where she was questioned and her temperature was found to be normal. She was subsequently informed of the DOH’s decision to quarantine her, until an Ebola infection was ruled out. Subsequently, she experienced the onset of fever, however, blood results indicated that Hickox had tested negative for Ebola. A DOH epidemiologist recommended keeping Hickox in isolation for 72 hours to permit observation since the cause of the fever had not been determined. After nearly four days in isolation, Hickox was released.

The Court held that there was no violation of Hickox’s Fourth Amendment rights, or her right to procedural due process under the Fourteenth Amendment. These findings were premised upon the Court’s determination that the state is authorized to maintain and enforce regulations that are necessary to prevent the introduction, transmission or spread of communicable diseases from foreign countries into the United States. This includes the ability to detain and medically examine people arriving into the United States who are suspected of carrying such diseases.

The Court held that there was no clear violation of Hickox’s Fourth Amendment rights and her detention did not constitute an unreasonable search and seizure, as the decision was measured, reasonable and not arbitrary. The defendants had probable cause to place her into quarantine, and were therefore entitled to qualified immunity for Hickox’s claims for violation of her constitutional rights. The State had reason to believe that Hickox was at risk of carrying Ebola, and consequently, to detain her. The Court ruled that her continued detention following her negative blood results did not constitute a violation of her rights as the state remained concerned about her unexplained fever. Furthermore, the period of quarantine did not exceed the incubation period of Ebola.

The Court also held that the quarantine did not deprive her of her right to procedural due process under the Fourteenth Amendment. The Court found that the public health officials’ conclusion regarding the plaintiff’s risk of Ebola, was based on an individualized assessment of her situation as a nurse returning from providing care to Ebola patients and her potential risk to the public. The Court also found that officials used appropriate means of containing the risk that Hickox had been exposed to or infected with Ebola and that less restrictive alternatives would not be sufficient. Finally, the Court maintained that the nature and duration of her quarantine had some reasonable relation to the purpose of protecting public health. The failure to provide Hickox with a hearing regarding her detention was not found to be a clear violation of due process given that her quarantine was only 80 hours long and she was released before such a hearing was required or practical.

“I cannot find that the decision to quarantine Hickox for a limited additional period of observation violated clearly established law of which a reasonable officer would have been aware. The facts do not suggest arbitrariness or unreasonableness as recognized in the prior cases—i.e., application of the quarantine laws to a person (or, more commonly, vast numbers of persons) who had no exposure to the disease at all. Indeed, her quarantine fits well within the Supreme Court's dicta in Jacobson, as well as the holdings in Reynolds and Shinnick.” (Page 593)

“I do not agree that the nature and duration of Hickox's detention was clearly unreasonable and unrelated to protecting the public. Plaintiff takes issue with the variation in her temperature readings, but the bottom line is that some of these temperature readings reflected a fever. I cannot rule as a matter of statutory or constitutional law that these medical professionals should have ignored the temporal thermometer readings and considered only the oral readings. Under the circumstances, the officials had to make a judgment, and they did so. The indications of fever are not attributed to some other, benign cause. Under the circumstances, ignoring indications of a fever in someone returning from working with Ebola patients in Sierra Leone could very well be deemed reckless.” (Page 600-601)

“I cannot find that the failure to provide plaintiff with a hearing regarding her detention was a clear violation of due process. The entitlement to a hearing must be understood in the context of an order of quarantine, which is necessarily prophylactic and peremptory. Plaintiff was released before such a hearing was required, or for that matter even practical. She was quarantined on a Friday afternoon and released on Monday, a period of approximately 80 hours. No body of clearly established quarantine or civil commitment case law establishes that she was entitled to a hearing within that timeframe. Once she was released from quarantine, the need for a hearing was mooted. Accordingly, I cannot find that any reasonable officer would have been aware that plaintiff's relatively short quarantine without a hearing was a violation of her constitutional right to due process.” (Page 602)