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Public Health and Law Enforcement:

Intersecting Interests, Collegiality

and Cooperation
William S. Duffey, Jr., JD
United States Attorney, Northern Distriet of Georgia

hank you for the privilege of being with you more constrained; we hold to a strict standard dealing

T today. One unexpected reward of my job as

United States Attorney has been my introduc-
tion to the public health community. The only other
only with admissible evidence with the focus on a
provable result. For us there are evidentiary and con-
stitutional standards and rules for what is presented
encounter I can recall having with you was in the six- to a jury for it to decide. For us it is citizen review. We
ties when I went to the county health office to take also often work secretly. We don't disclose what we
doses of the Sabin vaccine against polio. know to avoid tipping off a suspect or because our
Until this assignment my world as a lawyer did not legal rules require secrecy.
intersect with your world of public health. That we Public health, on the other hand, discloses com-
didn't intersect more is interesting because we are prehensive information in order to better warn and
engaged—in different ways—in a variety of issues in treat. Public health uses inductive reasoning to look
which both of our communities have a critical inter- beyond core facts to hypothesize and test theories.
est—especially since 9/11. For example, bioterrorism Hypotheses which lead to action are better than
has extremely important health and law enforcement allowing a problem to go unaddressed or undisclosed.
threats; in violent crime we focus on the defendant For you it is peer review, not citizen review.
while you focus on his or her effect on the public; in I understand your world to this extent: playing the
the area of controlled substances we focus on the traf- percentages is important to protect the public health.
fickers, you on substance abuse issues. Like baseball—putting in a left handed pitcher to
In addressing these issues, we have similar obliga- pitch to a left-handed batter. The odds urge this
tions even if we fulfill them in different ways. In the choice. To put it in the vernacular: Law enforcement
end we have shared goals and each seek to: believes you are too imprecise for us.
• Protect citizens You are too quick to respond, willing to act on spec-
• Redress wrongful conduct ulation and conjecture. Public health, however,
• Deter, and believes law enforcement is too narrow-minded, rigid
• Prepare to respond and pedantic, too conservative and too reluctant,
Is the reason we have not more closely worked wanting to follow every lead before reaching a firm
together because we did not recognize our inherent conclusion on which to act.
mutual interests? Or was it inadvertent oversight? What we have are colliding worlds where we ration-
Or did we believe—do we believe today—there are alize that it is easier, more efficient and less frustrat-
impediments to us working together in areas of com- ing to go our own ways rather than walk together.
mon interest? I don't think we can discount the pres- What has been the historical result? Incomplete reso-
ence of at least a disincentive to seek out each other's lution to problems which would have been better
cooperation and coordination. And I think that may addressed with a comprehensive solution.
be because the methods we use to reach our respective Is the environment the same today? Do failures in
objectives are inherently different. cooperation still occur? Do you remember the movie
In law enforcement our flexibility to experiment is Outbreak? It was the story of an African hanta virus


transported to California. You recall the story: (a) The for the Sun in Florida was sickened by anthrax. What
military's need to keep the virus—especially the anti- began as a public health probe became a criminal
body—a secret for national security reasons; and (b) investigation. We still struggled with balancing the
the CDC wanted full understanding of the threat and public health/public safety interests in this terrorist
an immediate public health threat response. The mil- attack. This is the post-9/ll terrorism reality. Six
itary and public health officials claimed they would months later the doctor who diagnosed the case—ini-
work together. Instead, they worked against each tially, it was considered an isolated case—said he
other. believed the federal government's reluctance to rec-
This is the question for us all: Do we work together ommend other anthrax-fighting antibiotics in addi-
or apart? Our experience suggests that we serve the tion to Cipro during the earliest days of the outbreak
public more efficiently and comprehensively when we created a bigger problem: "...this scare and this scarci-
cooperate and coordinate. I'd like to explore with you ty and this black market for Ciprofloxacin didn't have
four examples which I submit prove that point. They to occur." We were beginning to think differently, but
are: our response in this new world is still confusing.
• Terrorism/bioterrorism response The consequences of these acts still are unexpected,
• "Project Safe Neighborhood" gun violence initiative expensive and complicated. American Media sold its
• Drug abuse and trafficking, and anthrax-contaminated former headquarters to a
• Human trafficking developer for just $40,000 for a 68,000-square-foot
There probably is no clearer, more contemporary building on five acres of land but he would have to pay
example of public health's and law enforcement's up to $10 million for decontamination.
intersecting interests than in the area of terrorism and This incident did do one thing—it began to make us
bioterrorism. Criminal laws have been enacted to pro- think that while the public health and law enforce-
tect the pubhc health. 18 U.S.C. Sec. 2332 says it is a ment missions are different, they are equally impor-
crime when any person who, without authority, "uses, tant. As each incident occurs and failure of coordina-
threatens, or attempts or conspires to use, a weapon of tion reoccurs, the evidence builds that we need a new
mass destruction," including any biological agent, paradigm. We need to acknowledge that we have dif-
toxin, or vector....against any person within the United ferent jobs to do, that each is important. We need also
States." to acknowledge that we still struggle with each other.
In a bioterrorism response there are two compelling In Washington, D.C, in 2003 public health officials
interests, both embodied in this statute: (a) the need learned about the ricin contamination of the Dirksen
to understand the health threat and to protect the Senate Office Building from news reports. The Secret
public, and (b) the need to hold the bioterrorist crim- Service reported that it did not notify public health
inally accountable. Public health and law enforcement officials or other law enforcement agencies for five
interests are undeniably intertwined in this legislation. days. We thought the need to know was limited.
But there are inherent tensions as these two duties My tour of the CDC in 2002 brought home to me
are fulfilled. The immediate need to protect human how unfamiliar we are with each other. During my
health butts heads with the more methodical, delib- visit I looked down from a bridge that connected two
erate processing of evidence for a criminal case. We buildings. There below me was a trailer that I was told
have seen these interests run head-on before. In the was used to test ricin and other suspicious substances
Tylenol contamination incident the focus was on the and where it also could be processed as evidence—two
company's response to protect the public health. Law very important functions in a temporary, unsecured
enforcement's interests were a secondary considera- facility. It seemed to me it was a place where law
tion. enforcement could be invited in but kept out of the
In another case, in 1984, the followers of Bhagwan way. Yet these are two very important functions, one
Shree Rajneesh contaminated salad bars and coffee of which should be integrated into and not kept out of
creamers in Oregon with salmonella in an attempt to the work of the other agency. The overriding question
influence a local election: 751 people became ill; 45 is: How do you harmonize these two important inter-
were hospitalized. The initial response was to treat ests to bring about coordination, cooperation and col-
this as a public health issue. But years later, in an legiality? It is an issue I have thought deeply about
unrelated matter, authorities discovered the 1984 con- and about which I have developed deeply-held views.
tamination had been a terroristic attack. Clearly, there I'd like to share them with you for you to consider. I
should have been an aggressive law enforcement think these missions are harmonized when the follow-
response in 1984. ing happens:
Again, in October 2001, a 67-year-old photo editor • Cooperation and coordination occur most often


William S. Duffey, Jr.

when there are strong personal relationships. over the same quarter in 2002. Second, Grady saw 28
• Strong personal relationships create collegiality. percent fewer shooting victim admissions in 2003
• Collegiality allows people to plan and look for- compared with 2002. This data is real and it gives us
ward rather than react hy looking hack. a real goal. People understand these results. They point
That has heen the course we have followed with pub- out the human impact of our work. Law enforcement,
lic health officials, especially those at the CDC. We puhlic health officials, and the community see the
have addressed issues of suhstance, hut in a manner difference we really are making. It is, I think, the hest
that forges personal relationships. And we have used measure of success.
those personal relationships as the hasis for develop- The next example is in the area of methampheta-
ing cooperative strategies and plans that allow puhlic mine ahuse. Let's review the drug trafficking organi-
health and law enforcement communities collectively zations' trafficking patterns in our region. When you
to achieve their objectives. What we have tried to do focus on the destinations it hits you that every desti-
is create "the culture of cooperation" through: nation is a puhlic health issue.
• Joint seminars, conferences, and discussions Methamphetamine presents a puhlic health threat
• Joint tahle top exercises on many levels. Impact on the user is the single best
• Fostering personal interaction example of a drug-induced brain disease, according
The result is that it is harder to work against another to Richard Rawson, PhD, Associate Director of the
community's interests. UCLA Integrated Suhstance Abuse Programs. The
I would like to give you three more successful effects on users include: disturbed sleep pattern, bad
examples of creating cultures of cooperation where teeth, anorexia, itching/welts, nausea/vomiting,
law enforcement and puhlic health have intersecting aggressiveness, twitching/lip smacking/tongue pro-
interests: gun violence, methamphetamine ahuse, trusion, sexual dysfunction, kidney/liver/lung dam-
and human trafficking. age, and brain damage.
One example is "Project Safe Neighborhoods" How about the effect on families? Children are at
which focuses on gun violence. This is a huge public an especially high risk of neglect and abuse. The fire
health issue. Teenagers in America are more likely to risk alone is sobering. This year two parents were
die from gunshot than from all other natural causes sentenced for killing their child in a meth lab explo-
of death comhined. We can enforce all day and never sion. But there also is a risk of gun violence, and risk
address this public health/social issue. It is clear that of exposure to toxins. That's only part of it, however.
this is a public health and a puhlic safety concern. There are environmental risks as well. One pound of
"Project Safe Neighborhoods" is working in an at-risk meth generatesfiveto six pounds of toxic waste. Clean-
Atlanta neighhorhood because we finally have recog- up averages $5,000 and can cost as much as $150,000.
nized hoth issues, and through relationships have Contamination includes underground water.
hegun to address them cooperatively. It was a puhlic The only way to attack the meth prohlem is through
health goal that did the trick for me. What did we do? a coordinated approach. For example, legislation can
We measured results. Bernie Kerik, the former New he enacted to limit the sale of precursor chemicals
York City Police Commissioner, told me once: "If you such as cold tahlets, and to provide civil immunity for
don't measure it, it won't get done." What a truth! Dr. good faith reporting of someone suspected of buying
Art Kellerman's suggestion was that we should meas- precursors for meth production. And we should be
ure emergency room admissions at Grady Hospital advocating each of these together. Judicial steps can
here in Atlanta for gunshot wounds. Grady treats 85 he taken through drug courts and intervention with
percent of all shooting victims in Fulton and DeKalh offenders. Puhlic health can conduct outreach and
counties here in metro Atlanta. My reaction was treatment.
"Come on, get real. Art." This won't tell us anything. My final example is human trafficking. Our office
What do admissions have to do with stopping crime? has prosecuted seven cases of slavery and prostitution
But he was right. Improving the public's health is in which we locked up very had people. We made a
what propels support and cooperation. I think it was difference hut only a slight one. This is a terrible
our most important measurement. problem and it grieves me that our aggressive efforts
"Project Safe Neighborhoods" is making a signifi- only make a slight, incremental difference. The prob-
cant puhlic health and public safety difference. We lem is significant but under-appreciated. Here is an
can see what actually happened in two ways. First, 9- example of the travesty mentioned by U.S. Department
1-1 firearms calls dropped by 33 percent in the third of Health and Human Services Deputy Secretary
quarter of 2003 over the same quarter in 2002; they Claude Allen about a year ago: A thirteen-year-old
dropped hy 39 percent in the fourth quarter of 2003 girl was promised a job in the United States as a wait-


ress. When she got liere, she was forced into prostitu- tor trailer. In the hot sun of the southwest border the
tion. "She was brutally gang-raped to induct her into trailer literally baked its cargo. Is this a public health
the business. For the next six months, she v^^as forced as well as a law enforcement issue? You decide.
to service ten to fifteen men a day. Twice she was I believe that a new "rescue and respond" model is
impregnated, twice forced to have an abortion, and in order. The rescued are our greatest law enforce-
twice she was back in the brothel the next day. The ment response. The public health community is our
traffickers circulated her through the trailer brothels greatest law enforcement resource. Why didn't we
and private parties, where she was passed around. She work together before? The answer is because we were
was pistol-whipped and raped if she resisted. The girl myopic, looking at the problems through the lenses of
was rescued when two girls ran to neighbors who our own interests rather than looking to confront the
called police. She had multiple sexually transmitted problem comprehensively.
diseases, scar tissue from forced abortions, and was In conclusion, I have shared with you today four
addicted to drugs and alcohol. She had posttraumatic examples showing how we can work together. I pledge
stress syndrome, including severe depression and sui- to continue to make our case. This conference is
cidal thoughts. She was physically, mentally, and spir- another step in the right direction, hut there are many
itually broken." more to he taken. We need to work even harder at our
Closely related is the issue of human trafficking. As personal relationships to cultivate cooperation, coor-
we saw in a recent case in Texas, traffickers, in com- dination and collegiality. This is important work—you
plete disregard for human life, smuggled illegal aliens need to continue to do it because, ultimately, our com-
across the Mexican border by stuffing them in a trac- munities are counting on us to make a difference.