Collaboration between public health and law enforcement: new paradigms and partnerships for bioterrorism planning and response - Bioterrorism-Related Anthrax

Emerging Infectious Diseases, Oct, 2002 by Jay C. Butler, Mitchell L. Cohen, Cindy R. Friedman, Robert M. Scripp, Craig G. Watz

New Partnerships, New Paradigms

Although federal, state, and local public health plans for responding to bioterrorism contributed to a state of readiness that would not have been possible only a few years earlier, the response to the 2001 anthrax attacks required venturing into unfamiliar territory for many public health and law enforcement officials. Historically, most terrorist attacks on Americans have involved use of explosives (14), and investigations have been conducted by FBI and other law enforcement agencies, while public health involvement has generally been limited to ensuring safe working conditions for investigators and aid workers and assessment of the acute and long-term physical and mental health effects (15-19).

For many public health officials, responding to the rising threat of bioterrorism and recent attacks has necessitated a steep learning curve. Public health investigators usually approach infectious disease outbreaks as naturally occurring events, rather than the result of criminal acts, and they are unaccustomed to working closely with law enforcement personnel (11,12). Additionally, national security clearance has not been a requirement for most public health professionals, for whom the clearance process is unfamiliar. During 2001, few public health investigators had equipment such as secure telephone and fax lines necessary for sharing sensitive information with law enforcement officials. Confidentiality is maintained in public health investigations for the purpose of protecting sensitive patient medical information rather than national security. In law enforcement, confidentiality is also maintained to protect informants and witnesses and to preserve the integrity of the case for prosecution. Before 2001, most public health officials were not familiar with the principles of maintaining the chain of custody of specimens submitted for microbiologic testing so that laboratory results could be used for criminal prosecution.

Collaboration with law enforcement officials generally has not been recognized as beneficial or desirable in public health. The presence of law enforcement officers has been thought to compromise the collection of sensitive medical information (e.g., illegal drug use). Indeed, some degree of separation from law enforcement may be advantageous for obtaining complete and accurate data during public health investigations. Public health services are vitally needed by medically underserved communities, where suspicion of law enforcement agencies is intense, and collaboration with law enforcement agencies has even been described as "destructive to public health efforts" (20). However, the role of law enforcement in investigating potential bioterrorism incidents requires interviewing all potential witnesses and victims. Separate questioning by law enforcement and public health investigators may lead to conflicting statements by the interviewee, jeopardizing the admissibility of those statements in subsequent judicial proceedings. A process should be established whereby joint interviews by public health and law enforcement officials are conducted, with opportunity for confidential communications with public health officials regarding specific health-related issues that the interviewee may be unwilling to share with law enforcement personnel present. Both law enforcement and public health must recognize that the sharing of information can be crucial for identifying persons who have been exposed to dangerous agents and may be in need of prevention services such as chemoprophylaxis or vaccination.