Legal responsibilities of Port Medical Officers

1. To prevent confusion, the term "Port Medical Officer" should be restricted to mean "the medical officer for the Public Health (Aircraft) and Public Health (Ships) Regulations", as used in the glossary of the HPA port health review report (p37).

2. These regulations, known collectively as "the transport regulations", are;

Public Health (Aircraft) Regulations 1979 as amended 2007
Public Health (Ships) Regulations 1979 as amended 2007
Public Health (International Trains) Regulations 1994

There are duties and responsibilities for port Medical Officers set out in the ships and aircraft regulations. The medical involvement for enforcement action for international trains is as Proper Officer under the Public Health (Control of Disease) Act 1984 rather than any obligation contained in the train regulations.

3. The ships and aircraft regulations enable the "authorised officer" or the "medical officer" (see 10 below) to exercise specified legal powers. As such, medical officers and authorised officers need to be appointed, by the Local Authority, in the same manner as for the Proper Officer under the 1984 Act. The medical officer has some powers and obligations which the authorised officer does not have; care should be exercised to be aware of the difference where non-medical authorised officers are used.
4. The Transport Regulations contain obligations (the medical officer shall…) and discretionary powers (the medical officer may…). It is important to recognise these differences when framing the quality standards for duties pertaining to these regulations.
5. In essence, all three regulations place a responsibility on the captain or commander of a plane/ship/train arriving in an international travel terminal to notify the public health authority when there is suspected communicable disease on board. Similarly, the permitted responses are specified, to comply with the requirement of not interfering with international travel beyond the minimum required for appropriate action can be taken to protect the public health.
6. It follows that an appropriate response by a duly appointed medical officer should be available at appropriate ports and airports on a 24/7 basis within a response time which complies with the Quality Assurance Framework.
7. The response times for mandatory inspection by the medical officer is within three hours of an aircraft being detained (Regulation 14) and 12 hours for a ship.
8. The medical officer has the power to inspect an aircraft and normally any examination of passengers (or crew) may be carried out in the examination room provided at the airport without the necessity for him to board the aircraft. However, depending on circumstances, the interpretation of regulation 7 may require this.
9. A synopsis of the regulations is given below to illustrate the major provisions of the regulations. When applying the regulations, you are recommended to refer to the full text.
10. It is not necessary to appoint a medical officer at an aerodrome other than a customs airport. When an aircraft alights at one such, no-one may leave the aircraft except with the permission of an authorised officer (Regulation 25 of the aircraft regulations).
11. For the purpose of the regulations, the following definitions apply;

"Authorised officer" means the medical officer, the proper officer, or any other officer authorised by the local authority under regulation 4
"Infectious disease" means any infectious or contagious disease other than venereal disease or tuberculosis

Public Health (Aircraft) Regulations 1979, as amended 2007

Incoming aircraft

Regulation 7 Inspection of aircraft
1. An authorised officer may inspect any aircraft at a customs airport.
2. The medical officer, or other authorised officer acting on the medical officer's instructions, shall;
a) inspect on arrival any aircraft where the commander has reported infectious disease (regulation 12)
b) inspect any aircraft at the airport where there are reasonable grounds for believing that there is a case (or suspected case) of infectious disease
on board
3. The medical officer, or other authorised officer acting on the medical officer's instructions, may require an aircraft which he intends to inspect to be taken to some convenient part of the airfield.
4. Inspection of an aircraft may include taking from the aircraft samples of food or water for the purposes of examination.

Regulation 8 Examination of persons on board an aircraft
2. The medical officer may, and if requested by the commander, shall examine any person on board, or leaving, an aircraft when there are reasonable grounds for suspecting that;
a) the person is suffering from an infectious disease
b) the person has been exposed to an infectious disease
c) the person is verminous
3. The authorised officer may;
a) detain such person for examination
b) require the clothing and other articles to be disinfected and disinsected and any verminous person to be disinsected
c) prohibit any person examined to leave the airport, or to leave it on reasonable and necessary conditions set by the medical officer
d) require the commander to assist in taking necessary steps on board the aircraft to prevent spread of infection, disinsection or destruction of vermin and for removal of conditions likely to convey infection or other danger to public health

Regulation 9 Powers in respect of persons leaving aircraft
1. Where the medical officer suspects that a person intending to leave an aircraft has an infectious disease, the medical officer may cause that person to be sent to a hospital or some other suitable place, (except, for TB, to notify the medical officer of the intended destination address).

Regulation 14 Detention of aircraft
The medical officer may detain an aircraft for inspection where there are reasonable grounds for suspecting it has had on board a case of plague, cholera, yellow fever or smallpox and has not been subject to appropriate measures.

Regulation 18
The medical officer shall inspect any aircraft or persons on board as soon as possible and within three hours of being detained under regulation 14.

Regulation 20 Persons from infected areas
The medical officer may place under surveillance (see regulation 30)
a) any person disembarking from the aircraft who has come from an area infected with cholera, smallpox or VHF
b) any suspect disembarking from the aircraft who has come from an area infected with yellow fever, plague or VHF

Regulation 21 Removal of infected persons from the aircraft when required by the commander
If required by the commander of an aircraft, the medical officer shall remove any infected person from the aircraft (including anyone suffering from TB).

Regulation 22 Removal to an airport able to apply measures
If the authorised officer considers that any measure (under the regulations) should be made, whether to the aircraft or passenger(s), which that airport cannot apply, he may direct the aircraft, or person, to an airport able to apply the measures.

Regulation 24 Avoidance of delay
The authorised officer shall have regard to freeing the aircraft from control under the regulations as quickly as possible.

Outgoing aircraft

Regulation 27 Examination of persons proposing to embark
When an aircraft is going to depart outside the UK, the medical officer;
a) may examine any person, if he has reasonable grounds for believing him to have plague, cholera, yellow fever or smallpox and may prohibit his disembarkation
b) shall prohibit any suspect from embarking

Notes
Regulation 3 Armed forces
The armed forces of the UK, Commonwealth or any country under Visiting Forces Act 1952 are exempt from these regulations.

Regulation 26 Excepted area
These regulations do not apply to aircraft coming directly from Belgium, metropolitan France, Greece, Republic of Ireland, Italy, Luxembourg, Netherlands, Spain, UK, Channel Islands, Isle of Man.

Regulation 30 Surveillance
This sets out the maximum period of surveillance for the various diseases.

Public Health (Ships) Regulations 1979, as amended 2007

Incoming ships

Regulation 7 Inspection of ships
1. An authorised officer may inspect any ship on arrival or already in the district.
2. An authorised officer shall;
a) inspect on arrival any ship where the master has reported any illness or death under regulation 13
b) inspect any ship already in the district where there are reasonable grounds for believing that there is a case (or suspected case) of infectious disease
3. Inspection of a ship may include taking from the ship samples of food or water for the purposes of examination.

Regulation 8 Direction of ships
An authorised officer may require a ship to be brought to, or moored, at some safe and convenient place for medical examination.

Regulation 9 Examination of persons on ships
1. The medical officer may, and if requested by the master, shall examine any person on board a ship on arrival or already in the district when there are reasonable grounds for suspecting that;
a) the person is suffering from an infectious disease
b) the person has been exposed to an infectious disease
c) the person is verminous
2. The authorised officer may;
a) detain such person for examination, either aboard the ship or ashore
b) require the clothing and other articles to be disinfected and disinsected and any verminous person to be disinsected
c) prohibit any person examined to leave the ship, or to leave it on reasonable and necessary conditions set by the authorised officer
d) require the master to assist in taking necessary steps on board the ship to prevent spread of infection, disinsection or destruction of vermin and for removal of conditions likely to convey infection.
8. A ship shall not be required to be used for isolation of a person with, or exposed to, an infectious disease, if such isolation would delay or unduly interfere with the movements of the ship.

Regulation 10 Powers in respect of certain persons on ships
1. Where the medical officer suspects that there is a person on board who has an infectious disease, or TB, the medical officer may
i) cause the person to be removed from the ship and isolated or sent to a hospital or some other suitable place
ii) in the case of cholera, smallpox or VHF, place such person under surveillance (see regulation 36.1)
Regulation 11 Supply of information by masters
The master of a ship on arrival shall answer all questions as to the health conditions on board and shall notify the authorised officer immediately of any circumstances likely to cause spread of infectious disease or TB and notify the presence of animals or captive birds of any species or mortality or sickness among such birds or animals. "Captive birds" includes poultry.

Regulation 13 notification of infectious disease on board
The master of the ship shall, either directly to the local authority or through an agent, report;

the death of a person otherwise than as a result of an accident
Illness where the person has, or had, a temperature of 38o or greater, which has persisted for more than 48 hours, or is accompanied by a rash, glandular swelling or jaundice
Any illness or diarrhoea severe enough to interfere with work or normal activities
The presence of anyone who has an infectious disease or TB
Any circumstances on board likely to spread infectious disease or other danger to public health

Regulation 17 Restriction on boarding or leaving ships
Where the master has made a notification under regulation 13, no person (other than the pilot, customs or immigration officer) may board or leave until free pratique has been granted, without the permission of the authorised officer.

Regulations 21-28 Detention of ships
If a ship has had a suspected case of plague, cholera, yellow fever or VHF on board, within the last 4 weeks prior to arrival, it shall be directed to a mooring station. A ship which has been taken to a mooring station shall remain there until it has been inspected by a medical officer (regulation 25). The detention of the ship shall cease as soon as the ship has been inspected by the medical officer or within 12 hours (regulation 27). The medical officer shall inspect the ship and persons on board as soon as possible (regulation 28.1). The ship may continue to be detained by an authorised officer to apply further measures (regulation 28.2).

Regulation 31 Removal of infected persons from ships when required by the master
If required by the master of a ship on arrival, the medical officer shall remove any infected person from the ship.

Outgoing ships

Regulation 27 Examination of persons proposing to embark
When an ship is going to depart outside the UK, the medical officer;
a)   may examine any person, if he has reasonable grounds for believing him to have plague, cholera, yellow fever, smallpox or VHF and may prohibit his disembarkation
b)   shall prohibit any suspect from embarking
c)   any person on an international voyage who, on arrival, was place under surveillance, may continue his voyage

Notes;
Regulation 3 Armed forces
The armed forces of the UK, Commonwealth or any country under Visiting Forces Act 1952 are exempt from these regulations.

Regulation 36 Surveillance
This sets out the maximum period of surveillance for the various diseases.

Regulation 42 Ships unwilling to comply
If the master of a ship is unwilling to comply, the authorised officer may require the ship to leave the district immediately.

NMIB
July 2007

Last reviewed: 20 January 2009