JEFFERSON CITY, Mo. — After Missouri Attorney General Eric Schmitt sent threatening letters last week to health departments and school districts statewide demanding they drop their COVID-19 mitigation orders, a local school principal in Saline County wondered the next day whether to release a student from quarantine.
"So do I go ahead and allow the one kiddo that is quarantined to return to school?" Hardeman R-10 School principal Kristy Forrester asked Tara Brewer, the county health administrator, in an email.
Brewer replied two hours later: "According to the new ruling they're allowed to be in school."
For the past week, local health departments and school districts across Missouri have been scrambling to interpret a decision issued by a Cole County judge after Schmitt sent letters outlining the ruling and raising the prospect of lawsuits if local officials don't comply.
The decision declared key public health regulations unconstitutional, including provisions about notifying people exposed to contagious diseases. The ruling's consequences are likely to extend beyond COVID-19 and may limit how health departments respond to other diseases, such as tuberculosis and meningitis.
The ruling, from Judge Daniel Green, may be appealed. Jackson and St. Louis counties on Monday signaled they will attempt to fight it.
But Schmitt, armed with a favorable decision, has embarked on a sweeping public pressure campaign against health and education leaders that some officials liken to a form of legal terrorism.
His multi-front war against mask mandates, quarantines of schoolchildren and other orders to quash the virus have little precedent in recent Missouri memory. He casts them as unacceptable intrusions on personal liberty that will erode American freedoms.
"The last variant is communism," Schmitt, a Republican who is running for the U.S. Senate, tweeted Monday.
Emails obtained by The Kansas City Star show beleaguered public health officials over the past week sharing on-the-fly legal advice and receiving little help from the state health department. Much of Missouri's public health apparatus has descended into confusion, undermining the state's pandemic response as the number of COVID-19 hospitalizations rises quickly.
"What you're seeing right now is a little bit of chaos at the local level as a number of attorneys are weighing in," Clay Goddard, former director of the Springfield-Greene County Health Department, said in an interview.
Some health departments and districts have stood firm against Schmitt, accusing him of overstepping his role and pushing incorrect legal interpretations of the judge's decision. Lee's Summit schools, in particular, have all but told off the attorney general.
"Your invocation of 'rights' untethered to an obligation to exercise them responsibly invites lawlessness. This is especially pernicious coming from your office, because of the outsized weight some may attach to your opinions," Joseph Hatley, an attorney representing the district, wrote in a letter to Schmitt.
Jackson and St. Louis counties have also used blunt language in announcing they want to appeal Green's ruling. The two counties said in a court filing Monday that Schmitt had engaged in "a campaign of litigation terror against local governments and schools throughout the State."
Schmitt spokesman Chris Nuelle said in an email that the filings by the counties were "late and meritless." He said since the counties weren't parties during the litigation, "they have no authority to intervene and appeal."
Other health departments and districts have quickly reversed course after receiving Schmitt's letter.
Whether because they feared a potentially expensive court battle, lacked local support or were already looking for an opportunity to pull back, numerous officials have dropped efforts to quarantine students and ended mask requirements.
Blair Shock, the health administrator of Clinton County, north of Kansas City, said he suspects some agencies had a "knee jerk" reaction in essentially halting all pandemic control measures in response to potential lawsuits, even though officials likely believe they're in compliance with the ruling.
"And I'm aware of some agencies that have taken that tack likely to the detriment of the health of the citizens they serve," said Shock, a board member of the Missouri Association of Local Public Health Agencies.
More than half a dozen health departments, all in rural areas, have ended their COVID-19 response altogether following Green's decision and Schmitt's letters.
Asked whether the patchwork response statewide would hinder Missouri's efforts to combat the pandemic, Nuelle wrote in an email that "nearly 90% of school districts have figured out how to hold in person learning without any sort of mandates."
"I would argue that more school districts dropping their mask mandates and quarantine orders brings us closer to uniformity," he said.
The ruling and Schmitt's letters have created "a mess" across the state, said Rex Archer, a professor of population and public health at Kansas City University who led the city's health department earlier in the pandemic.
"This ruling goes way beyond COVID. This basically says that if a high school student gets meningitis, which is contagious and can kill a bunch of his friends and classmates, we can't do anything about that anymore," Archer said. "This is just plain crazy."
Emails show confusion
Emails obtained by The Star through records requests illustrate the uncertainty gripping public health officials.
In Maysville, east of St. Joseph, local superintendent Chris Heslinga traded emails with Tri-County Health Department administrator Teresa McDonald last Tuesday morning over whether it was possible Green's November court ruling, which Schmitt is enforcing, hadn't yet gone into effect locally.
After Schmitt's letter was sent that day, several health administrators wrote to each other, confused.
"Must we cease all covid orders including positive cases? Does this only include school cases?" wrote RaCail King of the Daviess County Health Department about an hour northeast of Kansas City.
"Why does it feel like we (are) all being set up for a large lawsuit???" wrote Gina Finney of the Mercer County Health Department, along the Iowa border. "Ugly."
Both Daviess and the Tri-County departments have said they will no longer issue quarantine orders for schoolchildren.
In eastern Missouri's Potosi, superintendent Alex McCaul wrote that the Missouri Department of Elementary and Secondary Education had advised districts not to change any practices yet because the ruling would not be effective until winter break.
McCaul's local health director, Shawnee Douglas of the Washington County Health Department, had not yet gotten any such word from the state health department. "I have no idea whose leadership I am supposed to follow at this point," Douglas wrote last Tuesday.
Much of the confusion comes from the conflict between the regulations Green struck down, as Schmitt outlines in his letter, and the laws and regulations that remain on the books.
For example, Green tossed a state health regulation specifying that "persons suffering from a reportable disease or who are liable to transmit a reportable disease ... shall be barred from attending school."
But another state law dating back to the 1960s, which was not discussed in the court case, states the same thing, and allows school officials to have students be examined by a doctor before sending them home.
Green also threw out a broad swath of regulations authorizing local departments to "establish appropriate control measures" to combat contagious disease, covering everything from isolation and quarantine to notifying potentially exposed people and the public.
Several paragraphs later in the same chapter of regulations, Green left untouched a section that states local health directors "shall require isolation of a patient ... with a communicable disease, quarantine of contacts ... or modified forms of these procedures necessary for the protection of the public health."
Caught in the middle and with Schmitt threatening litigation, strained local health departments were told by DHSS to seek their own legal advice. Some of the disease-control regulations at issue are more than a century old, Shock said.
"We've all operated within the confines of this rule for all of our collective careers and then to have the authority ... thrown into question, at this point, was a little unnerving and shocking," he said.
DHSS has promised local officials it will compile a frequently-asked-questions document for them. But it has little power over the ruling — it was the department being sued in the court case and represented by Schmitt. DHSS director Donald Kauerauf asked for an appeal of Green's ruling, but Schmitt refused.
DHSS did not respond to a request for comment Tuesday.
The lack of state guidance alarmed Douglas, from Washington County.
"I have followed DHSS guidance as closely as possible through this whole pandemic," Douglas wrote to a DHSS official last Tuesday. "Now I keep hearing consult your own legal counsel for guidance ... This is a mess."
Douglas wrote that the Washington County Health Department didn't have "a bunch of money to throw at a lawyer."
"I have been saying for months if DHSS doesn't step up and lead we are doomed. It is crazy to me that one judge in Cole County can make DHSS tremble in fear," Douglas wrote. "What is next? TB, Measles or mumps?"
DHSS posted on Facebook that it was awaiting state guidance and legal advice.
Privately, Douglas wrote a local hospital administrator, emergency services official and county commissioner that the local agency was reading the letter and ruling to mean "the positive can be quarantined, but we can no longer quarantine a contact."
"I'm afraid it is going to get a lot worse before it gets better," Douglas wrote. "I can only take comfort in the fact that we did our best ... We tried to follow all the guidance given to us, even when it was hard."
'Baseless attacks'
In contrast to the uncertainty statewide, Lee's Summit schools had sharp words for Schmitt.
Hatley, the district's attorney, wrote to the attorney general that schools were well within their legal authority to issue their own COVID-19 mitigation rules.
"Every COVID mitigation effort the District has undertaken has been guided by science, and has been aimed at ensuring that students can, to the greatest extent possible, receive in-person instruction," Hatley wrote.
Hatley said the school board is committed to standing up for teachers, principals and staff against "baseless attacks" on its legal authority to protect them against COVID-19.
On Monday, Schmitt sent a new letter to Lee's Summit schools urging the district to comply. While it included blustery language about constitutional freedoms, it contained no explicit threat of a lawsuit.
Schmitt has issued a lengthy list of letters but has so far sued no one under Green's ruling. New lawsuits could potentially lead to rulings less favorable to the attorney general and increase the chance an appellate court will overturn the Green decision.
"You ignore well-settled precedent that the Attorney General enforces the law and protects the public from injury to the general welfare," Schmitt wrote in the letter.
Asked if more litigation is planned, spokesman Nuelle said, "many school districts are taking action to bring their policies into compliance with the law, which wouldn't require any further action on our end in those cases."
The Missouri School Boards Association has pushed back on Schmitt, sending districts an email last week outlining state laws giving local officials the "authority and obligation to prevent the spread of contagious diseases in schools."
Still, several districts' elected boards on Monday voted to remove mask requirements and curb quarantine rules for the semester that will start in January.
Those include schools in Smithville and Kearney, where students who are close contacts of those infected with COVID-19 will no longer be required to stay home if they don't show symptoms. Masks will continue to be mandated on school buses, per a federal requirement.
In Smithville, superintendent Todd Schuetz presented the plan to the board of education after they met with counsel from the attorney general's office in closed session. The district was one of dozens that received additional cease-and-desist letters from Schmitt last week over their current masking and quarantine rules.
Board member Sarah Lamer said the district is still maintaining local control, but suggested the letters played a role in the Monday decision.
"I wanted (5- through 12-year-olds) to have the chance to get vaccinated before I remove the masks," she said. "So whether or not the attorney general sent the letter last week, I probably would have moved forward with removing masks as a requirement anyway. So that's kind of what irritated me last week."
Schmitt last week also took the step of urging parents to report districts with COVID mitigation rules to his office so that he could threaten further litigation. His office set up an email account "illegalmandates@ago.mo.gov" to receive the complaints and told parents to submit photos and videos from the schools "with proper lighting + horizontal orientation."
His official and campaign Twitter accounts have posted a slew of the complaints.
In one post, a parent complained to Schmitt's office that the director of a vocational school in the Columbia Public Schools district had called the police on their child and had the student removed over a masking dispute. Schmitt called it "unacceptable."
But the district has disputed that characterization of events. District spokeswoman Michelle Baumstark said the student left on his own after a school administrator, accompanied by an officer who was already on campus, responded to a call for assistance over the intercom.
Baumstark said the administrator and officer spoke with the mother over the phone and the student was neither arrested nor removed, "nor were either of those even considered as possible outcomes for the situation."
Reached for comment, Nuelle said his office received "video and audio that corroborated" the parent's story. A request for the police report filed with the Columbia Police Department turned up no records of the incident.
'State of shock'
Ultimately, Schmitt's actions amount to attacks on his own constituents, said Paul Nolette, a political science professor at Marquette University who studies state attorneys general.
"I think things are so polarized in general that it's ultimately likely to his benefit more than a negative to be going after the rather blue cities," Nolette said. "Because then it's kind of like, well, you're willing to bring the fight to your political enemies."
Schmitt, along with Ken Paxton of Texas, have been the most aggressive Republican attorneys general in targeting local pandemic policies, Nolette said. "Just in terms of the breadth of the pushback, I think Schmitt and Paxton really are on a different page" than other attorneys general, he said.
Whether Schmitt's scorched-earth campaign against COVID-19 mitigation measures will, in the end, be upheld in court remains unclear.
But the Senate hopeful has already left a growing trail of abandoned health orders and demoralized local officials in his wake.
"I think there's kind of a state of shock right now," Lynelle Phillips, vice president of the Missouri Public Health Association, said.
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(The Kansas City Star's Sarah Ritter contributed reporting.)
