Maine, attorneys could be headed for showdown over Ebola-negative nurse
State officials say they will seek a court order if Kaci Hickox does not comply with a quarantine.
By Scott DolanPortland Press Herald
Northern Maine Medical Center's Chief Medical Officer Michael Sullivan responds to questions from media regarding the Fort Kent hospital's preparedness for handling the Ebola virus on Tuesday.
FORT KENT — Top Maine health officials say the nurse who has returned from treating Ebola patients in West Africa must abide by a quarantine or the state will get a court order compelling her to do so. Her attorneys say she isn't under quarantine and they will fight any efforts to place her in one.
Tuesday's events appear to set up a showdown between the state and nurse Kaci Hickox, who this week fueled the debate over state Ebola protocols by criticizing mandatory quarantine procedures in New Jersey, where she was held against her will. Hickox apparently is in Maine, but not at her Fort Kent home.
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Dr. Michael Sullivan of Northern Maine Medical Center in Fort Kent answers questions about Kaci Hickox's quarantine and the hospital's preparedness for handling the Ebola virus. Hickox reportedly has no symptoms. Whitney Hayward/Staff Photographer
The house of nurse Kaci Hickox who is fighting her quarantine after returning home from ministering to Ebola patients in West Africa. Whitney Hayward/Staff Photographer
A photo showing nurse Kaci Hickox resting at an undisclosed location in Maine was taken by her boyfriend and tweeted by Emma Fitzsimmons, a New York Times reporter, on Tuesday.
Kaci Hickox, 33, of Fort Kent was forced to live in a tent outside a New Jersey hospital after returning from Sierra Leone, where she was helping treat Ebola patients while working for Doctors Without Borders. She has called the forced quarantine "inhumane." This unnecessary overreaction raises questions about official preparedness. University of Texas Arlington
NURSE kaci Hickox: TIMELINE OF EVENTS
FRIDAY: New Jersey Gov. Chris Christie and New York Gov. Andrew Cuomo announce that any medical workers returning from West African countries affected by Ebola will face mandatory quarantine upon arrival in their states. The same day, Maine nurse Kaci Hickox arrives at Newark Liberty International Airport at about 1 p.m. after traveling two days from Sierra Leone, where she had been working for about a month for Doctors Without Borders. A forehead scan shows a temperature of 101 degrees, prompting officials to transfer Hickox to University Hospital in Newark, where she is kept in an isolation tent in the parking lot. Another reading from an oral thermometer registered her temperature at a normal level, and a blood test later came back negative for Ebola.
SATURDAY: Hickox publishes an op-ed in The Dallas Morning News decrying her treatment and saying she worries about other returning health workers who may be made to feel like criminals, as she was. Christie defends the quarantine decision, saying Hickox is "obviously ill."
SUNDAY: Hickox appears on national television further criticizing her treatment. She hires a New York civil rights law firm.
MONDAY: Hickox is released from quarantine in New Jersey and begins traveling to Maine, where she lives in Fort Kent with boyfriend Ted Wilbur, who attends the University of Maine there. Christie maintains that the quarantine was properly imposed, saying that when Hickox "has time to reflect, she'll understand." Maine officials say they will work with Hickox to establish a voluntary quarantine, but will take "appropriate action" if she does not comply.
Robert Dixon, vice president of academic affairs at UMaine-Fort Kent, says Wilbur will not be allowed on campus until he is cleared of any Ebola risk.
TUESDAY: Hickox and Wilbur do not arrive at their home in Fort Kent. State officials announce they will seek a court order if Hickox does not comply with quarantine requirements through about Nov. 10. Her lawyers say she is isolating herself, but would fight any state effort to mandate a quarantine.
Hickox tested negative for Ebola after arriving in New Jersey from treating patients in Sierra Leone for Doctors Without Borders. She has no symptoms of the disease. Ebola is only transmitted through contact with bodily fluids.
The events in Maine took center stage in the national debate over protocols used to stop the spread of Ebola, with states offering differing views on how to protect the public while maintaining individual rights.
Arthur Caplan, founding director of the Division of Medical Ethics at New York University's Langone Medical Center, said actions taken by Maine health officials were not based on science.
"This quarantine has nothing to do with Ebola," Caplan said. "It has everything to do with fear."
A hastily arranged news conference by the Maine Department of Health and Human Services late Tuesday afternoon capped two days of conflicting, confusing messages from the LePage administration.
A LePage spokeswoman said Monday that Hickox's quarantine was voluntary, but then appeared to back off that statement later in the day. By Tuesday, the administration had reversed itself, saying Hickox must remain in quarantine or the state would go to court to enforce one.
"We are not willing to take the risk of exposure by an individual who came into direct contact with an Ebola patient, and it is on that basis that we are insisting on the 21-day quarantine for the duration of that exposure," said DHHS Commissioner Mary Mayhew. "We believe this is the safest way to ensure that public contact is limited."
Mayhew did not address Hickox's case directly, but said officials are prepared to seek a court order to enforce a three-week quarantine for people returning from Ebola countries in West Africa who treated people suffering from the deadly disease. Ebola has killed thousands in West Africa. In the United States, one person has died from the disease, and three health care workers have been infected.
"Our true desire is for a voluntary separation from the public," Mayhew said. "We do not want to have to legally enforce in-home quarantines."
But one of Hickox's attorneys, Norman Siegel, said they will battle to protect her freedoms.
"It's unconstitutional and illegal as applied to Kaci Hickox, who is asymptomatic and not a threat to the health, safety and welfare of the people in Maine," Siegel said by phone from New York. For the time being, Siegel said, Hickox is quarantining herself, but he maintained that she is free to move about.
Hickox's lawyers were in discussions with state health officials throughout the day Tuesday, but they said they were not told about the state's news conference or about the possibility of a court order.
Asked whether Hickox planned to leave the house where she is staying, another of her lawyers, Steven Hyman, said she is free to do as she pleases and wants to have the same options as any other citizen who is not infected with Ebola.
"At this point in time, Kaci is not a risk to anyone," Hyman said.
Critics of the LePage administration's response to Ebola say Maine is feeding into unfounded fears.
A quarantine would go beyond U.S. Centers for Disease Control and Prevention guidelines for health care workers who had treated Ebola patients and had not developed symptoms. Federal guidelines say such workers should be monitored but not isolated, and restriction of public activities should be determined on a case-by-case basis.
Caplan, the NYU bioethicist, said Maine and other states that quarantine such patients are overreacting.
"The flu kills 5,000 people per year," he said. "If we want to freak out about something, that's what we should be freaking out about."
By imposing a quarantine, the state is sending a message to the public that there's something to fear when there isn't, he said.
The Maine Center for Disease Control and Prevention, a division of DHHS, "is creating the fear because if she doesn't follow the quarantine, it's like she's not doing what the 'experts' are telling her to do," Caplan said.
State Rep. Richard Farnsworth, D-Portland, chair of the Legislature's Health and Human Services Committee, said the LePage administration should be following federal guidelines, which are based on sound science.
"We are responding in a hysterical manner. It's uncalled for," Farnsworth said.
But Mayhew said Maine is going beyond federal guidelines for travelers returning from Ebola-affected countries "out of an abundance of caution."
"The public is scared today," she said. "The public wants to know that their government is taking a leadership role with common-sense approaches to ensuring they are protected and they are safe. We believe this is a common-sense approach to minimize the risk to the people of the state of Maine."
Maine CDC director Dr. Sheila Pinette said Hickox "may have been tested too early" in New Jersey, and that there's a chance that early tests would produce a false negative for Ebola.
Some early tests for Ebola look for antibodies to the virus, which may not be detectable early in the 21-day incubation period.
Pinette said once people potentially exposed to the virus go beyond the 21 days, it's safe for them to venture out in public. But, she said, the Maine CDC can't be sure that the nurse doesn't have Ebola until the three weeks pass.
"We believe she may have been tested too early," Pinette said.
Melissa Maginnis, an infectious disease professor at the University of Maine who specializes in viruses, said the quarantine for a patient without symptoms is perhaps more about calming public fears than science.
"I don't know of a scientific reason" for a quarantine, Maginnis said.
A New York Times reporter tweeted a photo of Hickox sleeping on a couch at an undisclosed location in Maine. The tweet included a quote from Hickox's boyfriend, Ted Wilbur, that said she was getting "finally a bit of well-deserved rest after such a long ordeal."
Meanwhile, the chief medical officer at Northern Maine Medical Center in Fort Kent, Dr. Michael Sullivan, said he was told by Pinette that Hickox had agreed to quarantine herself in Maine.
As part of new Maine and federal protocols, Hickox would have her temperature taken twice a day while she is in isolation and be observed once per day, either in person or by an Internet video connection, Sullivan said.
During that time, Hickox would be allowed to have visitors who could freely come and go from where she will stay in isolation until Nov. 10, when the 21-day period in which state officials believe she would show symptoms of Ebola concludes, he said.
"Hopefully, Kaci does not contract Ebola. If she does, she's not contagious to anyone else until she's exhibited signs and symptoms," Sullivan said.
Sullivan spoke at a news conference at a health center across the street from Northern Maine Medical Center before a crowd of journalists from New York, Massachusetts and Maine.
"Although this is a scary disease in terms of the presentation and the mortality rate, it is a preventable disease with appropriate precautions," he said. "Our hospital is equipped with all protective equipment, and there are protocols in place, so there will be no public safety risk."
Hickox's plans to return home to Fort Kent changed after she was released on Monday and learned media from across the country had descended on the picturesque town near the Canadian border to await her arrival, Raymond Phinney, the associate dean of student life and development at the University of Maine at Fort Kent, said Tuesday morning. Wilbur, Hickox's boyfriend, is a nursing student at the school.
News of Hickox's intended return was the talk of the town this week in Fort Kent, which has about 4,100 residents and sweeping vistas of rolling hills overlooking the St. John River valley and Canada on the far side.
It seemed to be all people talked about from storefronts on Main Street, to the Town Office across the street from the border bridge to Canada, to a lunch spot on Market Street, which abuts a railroad lined with stacks of newly cut trees ready to be transported.
"They're just really nervous," Tammy Daigle said from behind the lunch counter at Stevie D's Panini Plus. "I think they are having a hard time understanding why she wants to come up here for quarantine."
Daigle, who co-owns the restaurant with her husband, said national media attention has caught Fort Kent residents off guard. The town is better known as a destination for snowmobilers and hunters than for journalists from "Good Morning America."
"We don't see any of that around here. Of all the places, it's happening here," Daigle said. "I hope (Hickox) understands we're not against her, we're just afraid. It's scary."
University officials announced Monday that if Wilbur had been in direct contact with Hickox since she was released from quarantine in New Jersey, he would not be allowed back on campus until he also had cleared health checks.
University officials learned Monday night that Wilbur would not return to campus until after the 21-day incubation period.
"Our conversation has been that he will be participating in the 21-day quarantine as well, so he will not be on campus," Phinney, the associate dean, said in his office at the university. He said the school would have a campus meeting at some point but he did not know when.
Students at the university campus said Monday that some classmates were panicked by the possibility that Wilbur might return to campus after being in contact with Hickox, and some vowed to boycott classes if Wilbur did return.
Meanwhile, LePage was campaigning Tuesday with New Jersey Gov. Chris Christie in Bangor. Hickox has criticized Christie because the state isolated her against her will in a tent at a New Jersey hospital after she arrived at Newark Liberty International Airport on Friday. A forehead test on Hickox showed she had a fever of 101 degrees, but Hickox has said she was flushed and angry and a subsequent test showed her body temperature was normal.
New Jersey has established a blanket quarantine for public health workers arriving to the United States from West African countries, going beyond federal CDC guidelines.
Staff Writer David Hench contributed to this report.
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