February 2014—Public Health Law News

CDC Public Health Law Program Externship. The CDC Externship in Public Health Law consists of 9–14 weeks of professional work experience, for academic credit, with CDC’s Public Health Law Program in Atlanta, Georgia. The program features rolling start and completion dates throughout the academic year. It exposes law students to the public health field, allowing for exploration of the critical role law plays in advancing public health goals. The unpaid externship is open to second and third year law students who are interested in exploring careers in public health law. Participants must receive academic credit. Applications for the summer 2014 program must be submitted by February 28, 2014; fall 2014 applications must be submitted by May 31, 2014; and spring 2014 applications must be submitted by November 1, 2014. Find more information and apply for the externship program.

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Job Opening. The Hopi Health Care Center, Administrative Services Division, is recruiting for a health system administrator (COO). This is a permanent, full-time position located in Polacca, Arizona. The COO will serve as a member of the healthcare delivery system’s management group to effectively meet clinical standards and achieve the best patient care possible. The application period closes on Friday, February 21, 2013. Find more information and apply for the position.

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National Association of County and City Health Officials 2014 Preparedness Summit. The 2014 Preparedness Summit will take place April 1–4, 2014, in Atlanta, Georgia. The event will provide one of the only cross-disciplinary learning opportunities in the field. The diverse range of attendees will include professionals working in all levels of government (local, state, and federal), emergency management, volunteer organizations, and healthcare coalitions. Find more information and register for the 2014 Preparedness Summit.

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Webinar: Update on Nurse Triage Line Project. On January 22, 2014, the National Association of County and City Health Officials hosted a webinar 1) explaining how a coordinated network of telephone triage lines may be useful during a severe pandemic; 2) identifying legal issues and concerns that may be associated with using such a triage network in an emergency; and 3) discussing possible solutions for resolving issues and concerns. Find more information and access the archived webinar.

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2014 Public Health Law Conference. The 2014 Public Health Law Conference will take place October 16–17, 2014, in Atlanta, Georgia. The conference will gather public health and legal experts from across the country to examine and discuss today’s critical challenges in public health law. Find more information about the conference and learn how to get the early bird registration rate.

Menus assessing state prescription drug overdose laws. The  CDC Public Health Law Program is pleased to release several menus assessing state prescription drug overdose laws: Menu of State Prescription Drug Identification Laws [PDF 332KB]; Menu of Pain Management Clinic Regulation [PDF 235KB]; and Menu of State Laws Related to Prescription Drug Overdose Emergencies [PDF 176KB]. These resources are designed to provide a picture of some of the legal and regulatory strategies states have used to address prescription drug misuse, abuse, and overdose. These menus were created through a partnership between CDC's Public Health Law Program and National Center for Injury Prevention and Control.

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ERISA issue brief. This issue brief is a summary of responses to technical assistance requests received by the CDC Public Health Law Program regarding the Employee Retirement Income Security Act of 1974 (ERISA) and its relationship to health benefit plans and state laws that address health system transformation. Find more information and read the ERISA Issue Brief [PDF - 272KB].

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State diabetes costs report. The National Conference of State Legislatures (NCSL) released States Address the Costs of Diabetes: a 50-State Budget Survey for Fiscal Year 2013, updating NCSL’s 50-state analysis of state diabetes budgets, tracking state and federal spending and appropriations on diabetes activities. Find more information and access the report [PDF - 188KB].

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LawAtlas maps. LawAtlas, part of Public Health Law Research, a national program of the Robert Wood Johnson Foundation based at Temple University, has published four new interactive LawAtlas maps: Medical Marijuana Laws for Patients; Communicable Disease Intervention Protocol; Insurance Billing Practices for Sensitive Health Services: Provider Immunity; and Insurance Billing for Sensitive Health Services: Limits on 3rd Party Billing. Find more information about LawAtlas and access other Public Health Law Research publications.

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Two new modules of the Model Aquatic Health Code. Two new modules of the Model Aquatic Health Code (MAHC) have been revised following public comment. MAHC is a science-based guidance document to help health departments reduce risk of drowning, chemical poisoning, and outbreaks at pools and other aquatic venues in their jurisdictions. The full version of the MAHC will be available for a final round of public comment in spring 2014. Interested stakeholders are encouraged to start compiling comments on the revised modules now. Find more information and access the new modules.

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Medical Countermeasures Authorities Q&A. The U.S. Food and Drug Administration (FDA) has released Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 (PAHPRA) Medical Countermeasure Authorities: FDA Questions and Answer for Public Health Preparedness and Response to Stakeholders to respond to questions raised by public health stakeholders about PAHPRA’s amendments to the emergency use authorization authority and establishment of new authorities related to the emergency use of medical countermeasures during chemical, biological, radiological, and nuclear emergencies. Find more information and access the FDA’s MCM Q&A [PDF - 762KB].

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Free e-learning resource on environmental public health. The National Association of County and City Health Officials has developed an Environmental Health Primer, a free e-learning resource that provides an overview of environmental public health, as well as modules on climate change, community environmental health assessments, the Environmental Public Health Performance Standards, and working with the media. Find more information and access the free e-learning resource.

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ASTHO 2014 State Legislative and Regulatory Prospectus. The Association of State and Territorial Health Officers (ASTHO) has released the 2014 State Legislative and Regulatory Prospectus. To provide an overview of the issues affecting state health agencies and public health, ASTHO reviewed available pre-filed bills and surveyed the state health agency legislative liaisons regarding priorities and issues they expect their legislatures to address in the coming year. The prospectus summarizes ASTHO’s findings and outlines emerging and ongoing public health issues to watch in the state legislatures for 2014. Find more information and download the 2014 State Legislative and Regulatory Prospectus.

Navajo Nation: Navajo Nation hikes sales taxes on ‘junk foods,’ makes healthy food choices tax-free
Food Safety News (02/03/2014)   Dan Flynn

On January 30, 2014, the Navajo Nation Council passed a law restructuring the Navajo Nation’s food sales tax system in efforts to encourage healthier food choices. Previously, all foods were subject to a five percent sales tax. Under the new law, nutritious foods such as seeds, nuts, fresh fruits, and vegetables carry no sales tax, but so called “junk foods” and all sugar-sweetened beverages will be taxed at seven percent, two percentage points higher than before.

The higher tax rate applies to all  snacks which are high in fat, sugar, and sodium but low in essential nutrient. Cookies, chips, candy, and pastries will all be subject to the higher tax rate.

“Each one of us here has a relative that’s diabetic, and we face that fact every single day,” said Council Delegate Danny Simpson. Diabetes is about 2.3 times more common within the Navajo Nation than in areas outside of the Navajo Nation.

The additional tax revenue is earmarked for a Community Wellness Development Project Fund, which will finance a variety of wellness-related venues including parks, swimming pools, walking, running, and bike trails, and community gardens.

[Editor’s note: Find more information about the Navajo Nation’s Healthy Diné Nation Act of 2013 [PDF - 262KB].]

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West Virginia: One month after toxic spill, West Virginians face ‘crisis of confidence’
New York Times   (02/09/2014)   Trip Gabriel

On January 9, 2014, up to 5,000 gallons of an industrial chemical used in coal processing seeped from a ruptured storage take into the Elk River, near Charleston, West Virginia. The spill contaminated the drinking water of 300,000 people across several counties.

The chemical, 4-methylcylohexane methanol, or MCHM, was released from a 35,000-gallon tank owned by Freedom Industries. According to the American Conference of Governmental Industrial Hygienists, MCHM smells like licorice; it can cause headaches, eye and skin irritation, and difficulty breathing from prolonged exposure at high concentrations.

Since the spill was identified, a ban was placed on the water and then lifted, only to have schools closed when the chemical was suspected in water again. Currently, MCHM levels in the water are reportedly safe, but citizens, frustrated and confused by the bans, are demanding answers and requesting legislation to prevent such spills in the future.

“If one smells the odor, people know the chemical is in the water. It’s difficult for a lot of people to drink it even if they agree with the science behind it,” said Dr. Rahul Gupta, director of the Kanawha-Charleston Health Department.

Policy analysts are hopeful that the crisis will lead to positive changes in West Virginia’s environmental regulations laws. “Typical regulatory legislation in West Virginia looks for a good headline, but when you read through it, there are all these loopholes,” said Marybeth Beller, a political scientist at Marshall University in Hunting, West Virginia. Beller also noted that the current situation is different because there is a “sustained outrage,” and the spill occurred in the state’s largest city during an election year.

[Editor’s note: Find more information about the January 9, 2014, Chemical spill in West Virginia and MCHM.]

Colorado: Concerns about tracking instances of driving under influence of marijuana
Colorado marijuana legalization’s impact on stoned driving unknown 
Denver Post   (02/10/2014)   John Ingold

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Connecticut: Parents of children with special needs petition legislature for assistance
Parents to lawmakers: Where will our children live when we die? 
CT News Junkie   (02/07/2014)   Christine Stuart 

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Florida: Legislature looks at creating statewide telemedicine standards
Florida lawmakers to explore telemedicine 
Tampa Bay Times   (02/09/2014)   Kathleen McGrory

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Missouri: Senate bill requires notification of dense breast tissue mammogram results
Mo. Senate passes mammogram notice legislation 
Kansas City Star   (09/06/2014)  
[Editor’s note: Find more information and read Missouri’s SB 639.]

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New York: Concerns that SAFE Act reporting requirements will discourage treatment
Catholic bishops: NY Safe Act gun reporting rules threaten services for mentally ill 
Times Union   (02/06/2014)   Casey Seiler
[Editor’s note: Find more information and read New York’s SAFE Act.]

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Oregon: Bill would create limited legal immunity for underage drinkers
Bill would give immunity to underage drinkers seeking medical help 
Statesman Journal   (02/06/2014)   Carol McAlice Currie
[Editor’s note: Find more information and read Oregon House Bill 4094.]

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Wisconsin: Seven new laws providing services for individuals with mental illnesses
Walker signs bills aimed at helping mentally ill 
Green Bay Press Gazette   (02/07/2014)   Paul Srubas
[Editor’s note: Find more information about Wisconsin’s new mental health laws.]

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National: Tribes to prosecute crimes committed in Indian Country by non-Indians 
New law offers protection to abused Native American women 
Washington Post   (02/08/2014)   Sari Horwitz
[Editor’s note: Find more information about the Violence Against Woman Act Reauthorization 2013, the U.S. Department of Justice’s Tribes’ Pilot Project implementing the new law on three pilot reservations.]

Akshara N. Menon

Title: Senior Legal Analyst/ORISE Fellow

Organizations: Public Health Law Program (PHLP), Office of State, Tribal, Local and Territorial Support, CDC

Education: J.D., Emory Law; M.P.H., Yale School of Public Health

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Public Health Law News (PHLN): What drew you to work in the public health law field?

Menon: When I was in college and law school, public health law was a fairly new and emerging field. I was drawn to its interdisciplinary nature and large-scale potential to use the law as a tool to improve health not just for an individual, but also for populations.  

PHLN: Please describe your career path to PHLP.

Menon: I was originally pre-medicine in college, and then took some classes that piqued my interest in the interdisciplinary study of law, bioethics, and public health. I began to hear more about the growing field of public health law, and decided to explore both educational and work experiences to further understand what it was all about. The more I learned about the field, I realized that I wanted to pursue a public health law career. After receiving my J.D. and M.P.H. degrees, I was looking for employment opportunities and was excited to find that CDC had established a public health law program committed to advancing the use of law as a public health tool. I was lucky to get an Oak Ridge Institute for Science and Education fellowship position with PHLP, and here I am!

PHLN: Can you briefly describe your day-to-day duties as a legal fellow?

Menon: Because our PHLP team primarily focuses on providing technical assistance to CDC programs and the state, tribal, local, and territorial (STLT) communities, my day-to-day duties include conducting research and analysis for legal assessments on various public health topics. Once a legal assessment is completed, I also help with writing and developing law-related tools and resources for STLT public health practitioners and policy makers.

PHLN: What do you mean by “legal assessments”?

Menon: Legal assessments involve collecting, analyzing, and coding STLT laws on a particular public health issue. We typically receive technical assistance requests from CDC programs or public health officials who would like to know how other STLT jurisdictions have used the law to address a particular public health problem. Thus, we conduct these legal assessments to help our public health customers understand the legal landscape.

PHLN: Can you please describe how you carry out fifty-state assessments and why they can be challenging?

Menon: To conduct a fifty-state assessment, the assigned PHLP attorney begins by understanding the specific issue the customer wants to know about and the kind of product they are envisioning. The PHLP attorney must learn more about the public health subject matter from the customer and also study the available literature. Once the PHLP attorney is familiar with the subject matter, she can search the Westlaw legal database for relevant laws. This is often where challenges arise because searches often produce a high number of results (sometimes thousands of laws!), which then requires refining search strings and conferring with the customer to establish the scope of laws to be collected.

Once all relevant laws have been collected, the PHLP attorney analyzes what the laws have in common with one another and how they differ from state to state. The content and variations between laws are coded by breaking down provisions into distinct elements that are assigned values. Such coding is an important last step to translate the law into a format that is accessible and useful to the customer.

This entire process can be time-consuming, which can be challenging when trying to meet the customer’s deadline.

PHLN: How do fifty-state assessments advance public health and public health law?

Menon: They are inventories of state legal strategies to address particular public health problems. Understanding the legal landscape and which legal tools are being used in states is an essential first step toward evaluating such public health laws’ effectiveness. Thus, fifty-state assessments are integral components to understanding how laws can be used effectively as a tool to advance public health.

PHLN: You’ve dedicated a great deal of time to a project on prescription drug laws, the results of which will be published in the coming months. Can you please describe the importance of this research and areas of focus within this research?

Menon: CDC has declared prescription drug overdose an epidemic in the United States. Because of the widespread nature of the problem, this has become a priority area for CDC’s National Center for Injury Prevention and Control and for PHLP. Based on discussions with experts in the field, CDC identified seven state legal strategies that have the potential to impact prescription drug misuse, abuse, and overdose. These seven types of laws include 1) laws requiring a physical examination before prescribing; 2) tamper-resistant prescription form requirements; 3) pain management clinic regulation; 4) laws setting prescription drug limits; 5) “doctor shopping” laws; 6) prescription drug identification laws; and 7) laws related to prescription drug overdose emergencies.

Starting in 2010, PHLP conducted fifty-state legal assessments in each of these seven domains. We’ve been working hard for the past two years to update and refine each of these legal assessments in the seven domains. We just published menus of laws on our PHLP website for three of the seven domains: state prescription drug identification laws, pain management clinic regulation, and state laws related to prescription drug overdose emergencies. We are finalizing our work on the remaining domains and hope to publish our findings soon. Because there is little information on the effectiveness of state statutes and regulations designed to prevent prescription drug abuse and diversion, our work is a first step in assessing such laws by creating an inventory of state legal strategies.

PHLN: What was the most challenging part of this project?

Menon: This project has involved conducting seven fifty-state legal assessments, requiring patience and focused reading of many, many laws! Being able to go through all laws found efficiently and only selecting those relevant to each domain was a challenging task.

PHLN: How do you hope this research will be used in the future?

Menon: We hope that our assessment work on state prescription drug laws will serve as an initial foundation for future evaluation and impact studies. 

PHLN: What other interesting projects are you working on?

Menon: Other interesting projects that I am currently working on include assessments about electronic health information; enabling authorities; and public health’s role in health system transformation.

PHLN: How can people learn more about PHLP and prescription drug laws?

Menon: They can find information on PHLP’s website. Our website contains a publications and resources section, which includes our prescription drug research. We plan to publish menus there on our legal assessment work for seven domains of prescription drug overdose laws.

CDC’s National Center for Injury Prevention and Control and PHLP have also developed a website that provides an overview of these seven types of state prescription drug laws and highlights which U.S. states have enacted them. This website is also in the process of being updated with our recent research findings.

PHLN: What’s your favorite aspect of working as a PHLP legal fellow?

Menon: What I like the best about our work is the diverse nature of projects we receive, which enables fellows like me to learn about different subject matter areas and expand my expertise in the field. 

PHLN: If you weren’t working in public health law, what would you likely be doing?

Menon: I would likely have pursued a career in international relations. 

PHLN: Describe any personal information, hobbies, or interests you care to share.

Menon: I enjoy travelling to new places, learning about other cultures and especially trying new foods. Brunch is my absolute favorite meal!

PHLN: Have you read any good books lately?

Menon: I’m a loyal fan of Mary Higgins Clark, and recently enjoyed reading her novel, “The Shadow of Your Smile.”

The first reader to correctly answer the Quiz question will be given a mini-public health law profile in the July 2014 edition of the News. Entries should be emailed to PHLawProgram@cdc.gov with “PHL Quiz” as the subject heading. Entries without the heading will not be considered. Good luck!  

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Public Health Law News Quiz Question: February 2014

The January 2013 Profiles in Public Health Law interviewees affiliated with which university?

Matthew R. Herington

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Winning response to the January 2014 Public Health Law News Quiz: California Supreme Court Justice Kathryn Mickle Werdegar

Employment organization and job title: Montana Department of Public Health and Human Services, Office of Fair Hearings, Hearing Officer

Education: J.D., University of Iowa College of Law; M.P.H. (international health), Loma Linda University School of Public Health; Graduate Certificate in Public Health (environmental health), University of West Florida School of Allied Health and Life Sciences; B.S. (liberal studies), Portland State University

Please describe your job. As a hearing officer for the Montana Department of Public Health and Human Services (Department), I conduct formal evidentiary hearings for individuals or entities who have been negatively impacted by a program administered by the Department. These hearings cover a wide variety of topics, including Medicaid (disputes regarding both recipients/applicants and providers);Temporary Assistance to Needy Families (TANF) benefits, child abuse and neglect substantiations; Supplemental Nutrition Assistance Program (SNAP) benefits, and childcare licensing. 

In doing so, I evaluate testimony, arguments, and evidence provided by the parties; research and interpret relevant statutes, policies, regulations, and case law; and write proposed decisions, including findings of fact and conclusions of law. The decisions are binding unless appealed to the Montana Board of Public Assistance, the Department director, or to a Montana district court. In addition, I serve as the presiding official for informal dispute resolutions requested by Montana nursing facilities that wish to challenge adverse survey findings.

What is your favorite section of the News? I particularly enjoy reading the “Feature Profiles in Public Health Law.” There is a lot of great work being done in public health law, and I appreciate learning more about some of the people who are contributing to that work. I also like the “Briefly Noted” section, which helps me keep abreast of some of the current public health law issues around the country. 

Why you are interested in public health law? To me, public health law is fascinating because it deals with some of the most difficult and controversial questions faced by contemporary society. What are the proper roles of federal, state, and local governments in assuring the public's health? How much coercion by a government is acceptable when promoting public health measures? How can an individual’s rights best be balanced against the good of society? These questions, of course, are not merely academic; indeed, how they are answered has an impact on matters of life and death. Although it is indisputable that law can be used to improve the public's health, I look forward to the continued evaluation of public health law interventions so that a stronger evidence base is developed in the coming years. I believe that attorneys and other legal professionals have an important role to play in developing these evidence-based practices, and I hope to be involved in that process.

California: Employer did not owe a preconception legal duty to employee’s child
Elsheref v. Applied Materials, Inc. 
Court of Appeals of California, Sixth District
Case No. H038333
Filed 01/27/2014
Opinion by Justice Eugene M. Premo

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Federal: No qualified immunity for lab supervisor in falsified drug testing case
Jones v. Han 
United States District Court, District of Massachusetts
Case No. 13-11196FDS
Filed 01/28/2014
Opinion by District Judge F. Dennis Saylor

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Federal: Red Cross not liable for nerve damage allegedly sustained while giving blood
Ross v. American Red Cross 
United States Court of Appeals, Sixth Circuit
Case No. 12-4312
Filed 01/27/2014
Opinion by Judge Julia Smith Gibbons

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Federal: California’s law on sexual orientation change efforts does not violate First Amendment
Pickup v. Brown 
United States Court of Appeals, Ninth Circuit
Case Nos. 12-17681, 13-15023
Amended 01/29/2014
Opinion by Judge Susan Graber

Navajo Nation Council Delegate Danny Simpson

“Each one of us here has a relative that’s diabetic, and we face that fact every single day,” said Navajo Nation Council Delegate Danny Simpson on the Navajo Nation’s new tax on unhealthy foods.