Public health professionals, especially local health departments and boards of health, are facing many questions from local public officials, residents, parents, health care providers and others about COVID–19. The following MAHB series of documents are meant to provide answers and guidance to health departments and boards of health. These documents are provided for educational purposes only and are not to be construed as legal advice. For legal advice, please contact your city or town attorney.
Frequently Asked Questions – Legal and Health-Related
Detailed Legal Guidance’s from MAHB Legal Staff
INSTRUCTIONS: Click on the RED FONT hyperlink to get a PDF version of the answer or click on the BLUE FONT Question (if available) to navigate to the online text answer.
Question 01.21: Update Cease and Desist and Notice of Violation Order Templates and Checklists for Local Public Health — please refer to March 19 2021 Updated LBOH Templates/Guidance on Final “Cease and Desist” and “Notice of Violation” Orders – MAHB updated March 19, 2021.
Question 01.20 What are the requirements for school-aged children having to receive an influenza vaccination prior to the end of 2020? –>VACCINATION GUIDANCE SCHOOL 11.3.2020
Question 01.19: What happens when enters a polling location to vote, can that person be refused a ballot if s/he refuses to comply with the order for all persons to wear a face covering, in the absence of a legally permissible exception such as an underlying health condition? Answer: Yes. –> Refusing to wear face covering 10.26.2020
Question 01.18 Are Smoking Bars, as defined in G.L. c. 270, § 22 permitted to be open during Phase III – Step 1? (8/27/2020). –> Final Smoking Bar Guidance 8.26.2020
QUESTION 01.017: What can a Board of Health do if a business or person refuses to follow the Governor’s emergency orders or other applicable public health and safety laws relating to a number of different issues such as: business, organization, or other non-business enterprise openings; wearing of masks or facial coverings; isolation and quarantine; maximum premises capacity; indoor and/or outdoor entertainment; proper “social distancing” of patrons or guests; food service preparation and delivery; indoor and/or outdoor recreational activities; summer day camps; day care services or congregate living facilities? If as a Board of Health you need to enforce these orders, get a copy of our generic COVID-19 Checklist Cease and Desist LBOH Order that can be issued to cover any one of these areas. Note a previous cease and desist order for failing to following essential businesses reopenings was posted below (Question 1.03a on 3/27/2020 and again on 8/5/2020). This item is now covered by this updated version. Link to Cease and Desist Generic “Checklist” Template –> FINAL C&D Template COVID-19 BOH 10.7.2020
QUESTION 01.016: What types of funding are available and permissible to local boards of health under the CARES Act? CARES ACT PUBLIC HEALTH EXPENDITURES GUIDANCE FINAL 7.6.2020
QUESTION 01.015: The following questions are answered in details in this Guidance (June 18, 2020).Facial Coverings, Graduations, Town Meetings_Revised
- Can an establishment require an employee to wear a face covering if the employee claims he or she has a medical condition? Answer: NO — Click on above pdf for details
- Can an establishment turn away a customer who is not wearing a facial covering because of a medical condition? Answer: NO — Click on above pdf for details
- Can a voter be turned away from a polling place because the voter is not wearing a mask? Answer: NO — Click on above pdf for details
- Is there any guidance for Graduations? Answer: YES — Click on above pdf for details
- Is there guidance for town meetings and town elections? Answer: YES — Click on above pdf for details
QUESTION 01.014: **Revised 5/19/2020**. Please note that the earlier guidance referred to “local public health officials” which has been replaced with “local public health officials or public safety officials”. With regard to the The Role of the Board of Health in the Postponement/Continuance of Town Meeting, can you offer guidance on the most important issues (May 12, 2020)? Semi-final Town Meeting Guidance v 1 (11) (2)
QUESTION 01.013: With regard to Farmer’s Markets and Governor Order, what guidance can you offer. (May 15, 2020) Farmers’ Market Memo FINAL 05152020
QUESTION 01.012: On March 23, 2020, the Governor signed Chapter 45 of the Acts of 2020 (“c. 45”), which authorized postponement of elections and caucuses, shifted registration deadlines, and implemented cost-saving measures in the election process.1 Does a Local Board of Health (LBOH) have any role in these changing election laws and procedures? (May 16, 2020). Link to PDF Answer –> GUIDANCE Election delays & BOH v1 (2) msbredlines05162020
QUESTION 01.011: With regard to the law “An Act to Address Challenges Faced by Municipalities and State Authorities Resulting From COVID-19”, as this new law affected local boards of health (LBOH) in the issuance and enforcement of various permits (May 9, 2020)? ANSWER 01.011: Yes. The new state law affects LBOHs and other municipal departments in their permitting roles. See complete answer and guidance by clicking on Permitting v3.5 (1) msbredlines05052020
QUESTION 01.010: What are the laws and regulations governing actions to enforce isolation or quarantine orders issued by state or local public health departments, based on coronavirus (covid-19) risks? (4/24/2020). Link to PDF Answer by clicking on Administrative Directive Superior Court 20-1-1 FINAL
QUESTION 01.009: What can/should local boards of health do about stores that sell both essential and non-essential goods? (4/17/2020) – Link to PDF Answer –>Stores selling both essential and non-essential services 4.21.2020 msbredlines042020
QUESTION 01.008: How does the “Health Insurance Portability Accountability Act” (HIPPA) affect local boards of health during the COVID-19 pandemic?(4/14/2020) – Link to PDF Answer –>HIPAA Guidance for LBOH 4.14.2020 msbredlines041320
QUESTION 01.007: What liability protections exists for licensed health care professionals?(4/8/2020) – Link to PDF Answer –>eds-liability-protections-handout
QUESTION 01.006: What legal authority do Boards of Health have to issue isolation and quarantine??(4/2/2020) – Link to PDF Answer –> I & Q memo msbredlines04022020
QUESTION 01.005: During a declared State of Emergency, can a quorum of members assemble and conduct Board of Health (BOH) business, including receiving updates on the status of the emergency, deliberating, and discussing issues anticipated to be part of a subsequent deliberation, without first posting notice?(3/20/2020) – Link to PDF Answer –> OML Notice emergency meetings v3 msbredlines033120
QUESTION 01.004: Are pet daycare centers, which provide grooming, essential services pursuant to the Governor’s Order Assuring Continued Operation of Essential Services in the Commonwealth, Closing Certain Workplaces, and Prohibiting Gatherings of More than 10 People (COVID-19 Order No. 13)?Link to PDF Answer –> Pet Daycare as Essential Services msbredlines033020 – also copied below. (3/31/2020)
QUESTION 01.003b: What other local emergency powers exist for cities and town in the case of a public health emergency?(3/23/2020 Link to PDF Answer —> Other Local Emergency Powers 3.23.2020 msbredlines3.23.20
QUESTION 01.003a: What can a Board of Health do if a business that offers a service that is not essential refuses to shut down? (3/27/2020) Link to Cease and Desist Generic Template –> COVID-19 Cease and Desist Order Template 3.27.2020 msbredlines032620
QUESTION 01.002: What local emergency powers exist for cities and town to close businesses that provide personal care services that require sustained physical contact and cannot comply with social distancing? (3/20/2020) Link to PDF Answer –> Local Emergency Powers 3.20.2020 msbredlines032020
QUESTION 01.001: Can local boards of health and health departments provide information about the physical location of quarantined individuals to police departments, fire departments and other first responders?(3/20/2020) Link to –> DPH – 911 GUIDANCE – SHARING OF CRITICAL INFORMATION WITH FIRST RESPONDERS and copy of the signed Order LBOH first responders order.3-18-20
ONLINE TEXT ANSWERS AVAILABLE FOR Questions 01.001 through 01.003b
QUESTION 01.004: Are pet daycare centers, which provide grooming, essential services pursuant to the Governor’s Order Assuring Continued Operation of Essential Services in the Commonwealth, Closing Certain Workplaces, and Prohibiting Gatherings of More than 10 People (COVID-19 Order No. 13)?
Please link to Pet Daycare as Essential Services msbredlines033020
ANSWER 01.004: Exhibit A to the COVID-19 Order No. 13 specifically designates “[o]rganizations and workers responsible for the care and custody of animals, pets and livestock” as essential services.1 Pet daycare centers, boarding facilities, and kennels (hereinafter collectively referred to as “animal care facilities”), and their employees, are responsible for the “care and custody . . . of pets” and therefore are providing an essential service.
If the animal care facility includes grooming in its scope of services, would the animal care facility still be considered an establishment providing an essential service? While
1 Exhibit A to COVID-19 Order No. 13 is available for download at https://www.mass.gov/doc/covid-19-essential-services.
While reasonable minds might differ, it is this author’s opinion that the definition of “grooming,” while not etched in stone, would include keeping an animal clean for its safety and the safety of the general public, especially in the case of an animal care facility that provides pet daycare. While in some instances grooming may include enhancing a dog’s physical appearance for showing or other types of competition, in the normal animal daycare setting, this is an unlikely scenario. For example, if at the pet daycare center there is one particular, regularly present dog that is in need of a bath because he played with a skunk, it is reasonable for the pet daycare center to bathe and groom the pet. If that same dog had played in a field that is frequented by deer, then it would be reasonable and necessary for the pet daycare center to perform tick checks and removal, which would include brushing the dog. These services assure that other pets present in the pet daycare center are protected from disease. Even if some grooming services are provided in addition to the daycare services, the hygienic care and cleaning of an animal can reasonably be considered essential. Summary: Pet daycare centers, boarding facilities, and kennels are essential services and in keeping with the Governor’s description of establishments responsible for the care and keeping of pets and animals. The bathing and grooming of the pet as part of the pet’s care and custody are included in the normal operations of the pet daycare center.
This information is provided for educational purposes only and is not to be construed as legal advice.
QUESTION 01.003b: What other local emergency powers exist for cities and town in the case of a public health emergency? (3/23/2020) — Retrieve PDF Copy of answer here —> Other Local Emergency Powers 3.23.2020 msbredlines3.23.20
ANSWER 01.003b: The authority of a board of health to respond to public health emergencies is embedded in many different state laws and regulations. The Massachusetts Supreme Judicial Court has made it clear that “[t]he right to engage in business must yield to the paramount right of government to protect the public health by any rational means.” Druzik vs. Bd. of Health of Haverhill, 324 Mass. 129, 139 (1949) (citing Lawrence v. Bd of Registration on Med., 239 Mass. 424, 428 (1921)).
Massachusetts General Laws Chapter 111, Section 122 requires boards of health to “examine into all nuisances, sources of filth and causes of sickness . . . which may [endanger] public health, [and] destroy, remove or prevent [them].” The statute also gives boards of health the authority to make regulations for public health and safety.
Typically, the board of health serves a “Cease and Desist Order” upon the individual or establishment responsible for the nuisance, orders the abatement of the nuisance, and requests the responsible party to come before the board for a hearing. The order must be in writing and served upon the owner or authorized agent of the establishment.1 These types of hearings are required by law to provide an individual with his or her due process rights. They are considered “quasi-judicial” because the board, after hearing the facts, can decide whether to shut down an establishment to prevent a public health threat.2
Emergency Situations and Due Process
The Massachusetts Sanitary Code permits boards of health to issue orders to address public health emergencies and require actions that are deemed necessary to meet the emergency, including shutting down establishments without holding a hearing. However, an individual who receives such an order may request a hearing by filing a petition and shall be granted a hearing no later than 10 days after the filing of the petition.3 The Department of Environmental Protection’s Environmental Code also permits boards of health to issue emergency orders. Similar to the Sanitary Code, an individual may request a hearing. However, under the Environmental Code, the hearing shall be granted “as soon as possible.”4
Board of Health Authority to Enact Reasonable Health Regulations
Massachusetts General Laws Chapter 111, Section 31 enables boards of health to make reasonable health regulations, including preventive regulations, to protect public health and safety. Once the board enacts a regulation, notice must be published in a local newspaper, and this publication shall be considered notice to all individuals. The only regulations that require a hearing prior to enaction are those that relate to the subsurface disposal of sanitary sewage.5 While MAHB’s position has always been that a public hearing should be held prior to enacting any regulation, a hearing is often not legally required.
1 SEE MASS. GEN. LAWS ch. 111, §§ 122-25.
2 See Nelson v. State Bd. of Health, 186 Mass. 330, 334-35 (discussing quasi-judicial nature of board of health’s powers).
3 105 CMR 400.200(B).
4 310 CMR 11.05.
5 MASS. GEN. LAWS ch. 111, § 31.
City and town attorneys are solely responsible for providing legal advice to their clients and MAHB urges boards of health and other municipal officials to consult with them prior to issuing any emergency orders.
This information is provided for educational purposes only and is not to be construed as legal advice.
QUESTION 01.003a: What can a Board of Health (BOH) do if a business that offers a service that is not essential refuses to shut down?
By consulting with their Town Counsel and the DPH Guidance’s, the BOH of Health should get a legal opinion that the business is definitely not exempt and performs an essential service. When it is certain that the business services or part of those services are non-exempt, then a Cease and Desist Order can be issued by the BOH. A generic template of a Cease and Desist Order can be found here –> COVID-19 Cease and Desist Order Template 3.27.2020 msbredlines032620
QUESTION 01.002: What local emergency powers exist for cities and town to close businesses that provide personal care services that require sustained physical contact and cannot comply with social distancing? (3/20/2020) You can find a PDF version of this Guidance by clicking on –>Local Emergency Powers 3.20.2020 msbredlines032020
Public health professionals, especially local health departments and boards of health, are facing many questions from local public officials, residents, parents, health care providers, and others about COVID–19. MAHB’s series of documents are meant to provide answers and guidance to health departments and boards of health. This document is provided for educational purposes only and is not to be construed as legal advice. For legal advice, please contact your city or town attorney.
ANSWER 01.002: On March 10, 2020, Governor Baker declared a state of emergency in Massachusetts to “facilitate and expedite the use of Commonwealth resources and deployment of federal and interstate resources to protect persons from the impacts of the spread of COVID-19.” (Executive Order No. 591: Declaration of a State of Emergency to Respond to COVID-19, available at https://www.mass.gov/executive-orders/no-591-declaration-of-a-state-of-emergency-to-respond-to-covid-19). As a result of the declaration, the Governor has taken the following steps to date:
• Suspended Elementary and Secondary School Operations from March 17, 2020 until April 6, 2020;
• Limited gatherings of individuals to 25 individuals;
• Prohibition of on-premises consumption of food and/or alcohol effective from March 17, 2020 until April 6, 2020;
• Placed restrictions on hospital visits, including a limitation of one visitor at a time, increased hand hygiene, a prohibition of visitors under the age of 18, and other restrictions;
• Placed restrictions on assisted-living-facility visits, with guidelines being issued by DPH (available at https://www.mass.gov/info-details/covid-19-guidance-and-directives#for-long-term-care-facilities) and the Executive Office of Elder Affairs (available at https://www.mass-ala.org/wp-content/uploads/2020/03/ALR-COVID-19-Guidance-03-11-20-_1_.pdf);
• Issued a Pharmacy Hand Sanitizer Order permitting pharmacists to compound and sell hand sanitizer that confirms to FDA requirements;
• Cancelled non-essential elective hospital procedures;
• Extended Registry of Motor Vehicles renewal timelines of certain credentials;
• Required that all insurers cover medically necessary telehealth services related to COVID-19;
• Modified certain requirements of the Open Meeting Law to enable state and local governments to carry out essential functions, including remote participation in meetings;
• Placed restrictions on Nursing home visits;
• Modified policies for nursing licensure applications to expedite processing of reciprocal licenses; and
• Expedited credentialing procedures for licensed independent practitioners.
Since the Governor’s declaration of a state emergency, some cities and towns have issued their own “emergency declarations.” The Governor’s authority to issue emergency declarations is clear pursuant to the Civil Defense Act of 1950. The authority of the Chief Executive Officer (CEO) of a municipality—typically the Mayor, City Council, City Manager, Board of Selectmen or Town Manager—to declare an emergency is found in this same act.1
However, the authority of the Board of Health to respond to public health emergencies is not clearly delineated in one law, but instead is embedded in many different state laws and regulations. The legal authority for Boards of Health to respond to the spread of dangerous and infection diseases is found in sections 95 through 105 of Chapter 111, of the Massachusetts General Laws, which address (i) monitoring and tracking people infected and people exposed to those infected, including the use of isolation and quarantine orders; (ii) reporting requirements; and (iii) means boards of health can use in protecting public health.
In implementing the above-described sections of the law, a board of health must use the least restrictive measure(s) available to accomplish its goal. Members of our society enjoy certain constitutionally protected individual rights. When the government restricts rights, it must carefully weigh the rights of individuals versus the obligation to protect public health. The Massachusetts Supreme Judicial Court has made it clear that “[t]he right to engage in business must yield to the paramount right of government to protect the public health by any rational means.” Druzik vs. Bd. of Health of Haverhill, 324 Mass. 129, 139 (1949) (citing Lawrence v. Bd of Registration on Med., 239 Mass. 424, 428 (1921)).
City and town attorneys are solely responsible for providing legal advice to their clients and MAHB urges boards of health and other municipal officials to consult with them prior to issuing any emergency orders. Massachusetts General Laws Chapter 111, Section 104 permits “the selectmen and the board of health [to] use all possible care to prevent the spread of [an] infection” that is dangerous to public health. (See Mass. Gen. Laws. ch. 111, § 104). Typically, the CEO declares a public health emergency and the Board of Health issues orders pursuant to that declaration. However, as stated above, municipal attorneys are the only attorneys who can provide legal advice on these topics.
Currently many municipalities, including but not limited to, Boston, Walpole, Worcester, Brookline, Somerville, Marlborough, Medford, Weymouth, Malden, and Winchester have issued Executive Orders that declare public health emergencies and complement the statewide order. Brookline’s order limits lines at retail stores to 10 people or less, except in grocery stores and pharmacies. Somerville closed all social clubs until at least April 6, 2020.
Several boards of health, like those in Malden, Medford and Winchester, have ordered that all services offered to the public that require sustained physical contact and cannot comply with social distancing requirements be closed until further notice. These orders, which are available on the municipalities’ websites, apply to services like hair salons, barber shops, nail salons, and tattoo and massage establishments.
Guidance on board of health legal authority pursuant to the nuisance laws and pursuant to the legal authority to enact reasonable public health regulations will follow.
This information is provided for educational purposes only and is not to be construed as legal advice.
1. 1950 Mass. Acts 520.
QUESTION 01.001: Can local boards of health and health departments provide information about the physical location of quarantined individuals to police departments, fire departments and other first responders?
The previous ANSWER 01.001 was revised on Friday, March 20, 2020 4:56 PM — see notices below.
The Guidance and Order described below was circulated to all BOHs by
From: Ohannessian, Dana (DPH) <email@example.com>
Sent: Friday, March 20, 2020 4:56 PM
Subject: DPH and 911 – Joint Guidance for Local Boards of Health Re: COVID-19 Information Sharing
Dear Local Public Health Colleagues,
As you know, on March 18, 2020, the Massachusetts Department of Public Health (DPH) issued an Order of the Commissioner regarding the sharing of critical information with first responders. Local boards of health shall disclose to the (Receiving Entity) the addresses of persons living in their jurisdiction who the local board of health has been informed have tested positive for COVID-19. The disclosure of information shall be limited to the address, and shall not include any other identifying information, including name.
The “Receiving Entity” is described in the Order as “the official with the responsibility for administering the response to emergency calls in their jurisdiction.” For local Boards of Health, there may be some misunderstanding about to whom they should forward that information.
To avoid any confusion, DPH and the Massachusetts State 911 Department would like to make it clear that the local boards of health should disclose the addresses to the Public Safety Answering Point of jurisdiction. The PSAP of jurisdiction for each city or town is the appropriate Receiving Entity.
Please find a copy of the guidance
DPH – 911 GUIDANCE – SHARING OF CRITICAL INFORMATION WITH FIRST RESPONDERS and copy of the signed Order
LBOH first responders order.3-18-20
Thank you for your ongoing partnership with us in our response to the COVID-19 pandemic.
Covid-19 Response Team
Executive Office of Health and Human Services
Ron O’Connor, MPH
Director, Office of Local and Regional Health
COVID-19 Information for Local Boards of Health – https://www.mass.gov/info-details/covid-19-information-for-local-boards-of-health
COVID-19 web site: www.mass.gov/covid19
MDPH online resources
Local and Regional Health pages: www.mass.gov/dph/olrh