## Facts

- Kaci Hickox, a nurse, returned to Maine after treating Ebola patients in Sierra Leone during the 2014 Ebola outbreak.
- Upon returning to the United States, Hickox was detained in New Jersey despite being asymptomatic and testing negative, then traveled to Maine to stay in Fort Kent.
- Maine health officials categorized Hickox as “high risk” and sought a 21-day home quarantine period based on Ebola’s incubation period.
- Hickox stated she was healthy and refused to comply with a voluntary home quarantine, citing public-health guidance that asymptomatic individuals do not transmit Ebola.
- The Maine Department of Health and Human Services, through its Commissioner, petitioned for court-ordered public-health measures restricting Hickox’s movement, including staying out of public places, not using public transportation, not working, and maintaining a three-foot distance from others during outdoor activity.
- The State relied on an affidavit from the Maine CDC director asserting that movement restrictions were the “surest” way to reduce public-health risk during the incubation period, while also acknowledging that asymptomatic persons cannot transmit Ebola.
- The court initially issued a restrictive ex parte temporary order, then vacated it after a telephonic hearing and entered a narrower temporary order pending a further hearing.

## Issues

1. Whether the State proved, under Maine communicable-disease control statutes, by clear and convincing evidence that quarantine-like restrictions on an asymptomatic individual were necessary to protect others from infection.
2. Whether narrower measures consistent with accepted public-health guidance (direct active monitoring and coordinated travel) sufficiently protected public health while reducing restraints on individual liberty.

## Decision

- The court denied the State’s request for broad movement restrictions and home confinement, finding the State had not shown by clear and convincing evidence that such restrictions were necessary to protect others from infection.
- The court entered a revised temporary order requiring:
  - Direct active monitoring by a public-health official at least daily,
  - Coordination of any travel with public-health authorities, and
  - Immediate notice to public-health officials and compliance with directions if symptoms developed.
- The order did not bar Hickox from public places or public transportation and did not impose a physical-buffer requirement.

## Legal Principles

- Court-ordered public-health restraints that substantially limit liberty require a heightened evidentiary showing—commonly framed as clear and convincing evidence—that the specific restrictions are necessary to protect others from infection.
- A documented risk of future illness during an incubation period is not, without more, proof of a current transmission risk justifying broad quarantine-type restrictions on an asymptomatic person.
- Where evidence indicates an asymptomatic person cannot transmit the disease, less restrictive measures tailored to monitoring and rapid response may be ordered in place of generalized movement bans.
- Public-health orders should be grounded in reliable scientific evidence rather than fear or misinformation.

## Conclusion

The court refused to impose sweeping Ebola quarantine restrictions on an asymptomatic nurse, holding the State failed to prove such limits were necessary under a clear-and-convincing-evidence standard; it instead ordered only daily direct monitoring, coordinated travel, and immediate reporting and compliance if symptoms arose.


Mayhew v. Hickox, No. CV-2014-36 (Me. Dist. Ct. Oct. 31, 2014)