August 2014—Public Health Law News

Health system transformation webinars. CDC’s Public Health Law Program (PHLP) and the American Health Lawyers Association are co-hosting a three-part series of webinar roundtable discussions that will provide lawyers, in-house counsel, and academics an overview of health system transformation. The series will discuss PHLP’s research on law and policy related to health system transformation, accountable care organizations, and hospital presumptive eligibility for Medicaid. PHLP reserved 200 free registration spaces. Please register as soon as possible to ensure free registration. The next webinar will take place Monday, September 22, 2014, from 2:00 to 3:30 pm (EDT). 

CDC Public Health Law Program externship. This externship 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. Spring 2015 applications must be submitted by November 1, 2014.

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. An early bird registration rate is available.

2014 APHA Meeting. The American Public Health Association’s (APHA) 142nd Annual Meeting, themed “Healthography: How Where You Live Affects Your Health and Well-Being,” will take place in New Orleans, November 15–19, 2014, at the Ernest N. Morial Convention Center. Register by August 28, 2014, for the early registration discount. Advanced registration deadline is October 3, 2014. Registration fees increase after October 3.

Accountable care resources. Public Health Law Program announces the publication of three accountable care resources: Accountable Care: Basic Principles and Related Law, describing accountable care frameworks and the legal provisions that support them, an Accountable Care Presentation, and a Research Anthology for Accountable Care. These resources can help practitioners understand how accountable care might impact public health and engage with accountable care entities in their jurisdictions.

Assessment of Radiological incidents response laws [PDF 669KB]. The Public Health Law Program published Public Health Preparedness: Examination of Legal Language Authorizing Responses to Radiological Incidents, an assessment of state and local laws that authorize restriction of movement and decontamination of people during a radiological event. The assessment is a the result of a partnership between the Public Health Law Program, CDC’s National Center Environmental Health, Radiation Studies Branch, and the National Association of County and City Health Officials.

Interactive map on federal minimum wage laws. The Public Health Law Research Program (PHLR) released a new map charting the changes in the federal and state minimum wage laws dating back to 1980. The map is one of more than 25 on the PHLR LawAtlas.org website that tracks laws across states and over time in more than 10 public health issue areas, including chronic disease, injury and violence prevention, and environmental health. 

Health impact assessment legislation report. [PDF 610KB] The National Conference of State Legislatures released Health Impact Assessments: An Analysis of State Health Impact Assessment Legislation, May 2014, a new resource supported by the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. A health impact assessment (HIA) is a tool that policymakers can use to gauge the potential health impacts of a policy or project. HIAs allow state lawmakers to tailor policies in order to avoid or mitigate negative health impacts. HIAs can be used in a wide variety of policy areas, from transportation projects to pollution prevention to new energy facility siting decisions.

Ebola webinar. The Network for Public Health Law (the Network), CDC’s Public Health Law Program, and the American Health Lawyers Association co-hosted a free webinar, Ebola and the Law: What You Need to Know, on August 12, 2014. The webinar, which is archived on the Network’s website, describes the recent outbreak of the Ebola virus in Guinea, Liberia, and Sierra Leone, discusses legal issues that arise when infected patients enter the US, and explores legal powers and duties health department personnel have if an Ebola outbreak occurs in the US.

Ebola hemorrhagic fever updates. CDC offers the latest information about the Ebola outbreak, including comprehensive epidemiological information, updates, reports, and tracking.

Journal article on Ebola epidemic. The Journal of the American Medical Association released The Ebola Epidemic: A Global Health Emergency by Lawrence O. Gostin, Daniel R. Lucey, and Alexandra Phelan, published online August 11, 2014. (doi:10.1001/jama.2014.11176). The article discusses the West Africa Ebola crisis’ status determination as a “public health emergency of international concern,” and how such status triggers specific powers under the International Health Regulations.

National: Uncharted territory: HIPAA in the big data era

The Morning Consult   (07/27/2014)   Jonathan Easley

As the health industry moves towards coordinated care, new technologies, and cutting costs, providers, insurers, and health information technology professionals are concerned that existing regulations regarding patient privacy are inadequate. The 1996 Health Insurance Portability and Accountability Act (HIPAA) governs the transfer of health information data and imposes sanctions and fines for data breaches.

Many worry the laws regarding patient privacy, which were largely written without consideration for cloud technology and the rapid pace of the current tech-age, are impeding progress, efficiency, and discouraging businesses to engage in healthcare innovation.

“To help accelerate the delivery of new biomedical treatments and cures, Congress could work with the Department of Health and Human Services to modernize implementation of [HIPAA] so that healthcare providers can readily employ the benefits of cloud computing without any compromise of the strong privacy protections HIPAA now affords health information,” Paul Milsner, Amazon’s vice president for global public policy, told Congress’s House Energy and Commerce Committee in July.

Under many new state laws and the Patient Protection and Affordable Care Act (ACA) providers are often encouraged and given financial incentives to work together in what are known as accountable care organizations. While coordinated care is designed to improve health outcomes and reduce inefficiencies, HIPAA questions are compounded as providers begin to coordinate care across private and public health systems in accountable care organizations.

“HIPAA was enacted in 1996 and they couldn’t have anticipated the current healthcare environment. When everyone worked in individual silos, it was clear, but now they’re encouraging people to practice across a continuum, so that’s where there’s some confusion, and this is undermining the effort to leverage data for quality and efficiency, so we need some clarification and guidance,” said Blue Cross-Blue Shield of North Carolina (BCBSNC) Chief Medical Officer, Susan Weaver. BCBSNC is operating several programs supporting coordinated care.

In the meantime, several US Senate and House representatives have expressed interest in updating HIPAA and organizations such as the American Medical Association are educating their members.

[Editor’s note: Read more about HIPAA and other resources related to HIPAA and the ACA. Also explore Health System Transformation and Improvement Resources for Health Departments, published by CDC’s Office for State, Tribal, Local and Territorial Support.]

Illinois: Community health worker bill to support under-served communities
Gov. Quinn signs community health worker law
Examiner.com   (08/01/2014)   Gailann Jarocki
[Editor’s note: Read Illinois House Bill 5412.]

South Dakota: Police use Taser on knife-wielding eight-year-old, mother sues city
Using a Taser on an 8-year-old? Mom sues police, city
CNN   (08/09/2014)   Mark Morgenstein

Tennessee: Unvaccinated pets exposed to rabies subject to euthanasia or quarantine
Local rabid skunk points to importance of vaccinations
Herald and Tribune   (08/12/2014)   Karen Sells

National: Legal analysis of Burwell v. Hobby Lobby Stores, Inc.
APHA, health law program break down Hobby Lobby’s public health impact
Public Health Newswire   (08/04/2014)  
[Editor’s note: Read Burwell v. Hobby Lobby Stores, Inc., 134 S. Ct. 2751, 2755 (2014) [PDF 342KB].]

National: National Academy of Sciences releases congressionally mandated report
Committee reports on nuclear hazard planning shortfalls
Global Biodefense   (07/28/2014)  
[Editor’s note: Read the report, Lessons Learned from the Fukushima Nuclear Accident for Improving the Safety of U.S. Nuclear Plants, and PHLP’s Examination of Legal Language Authorizing Responses to Incidents Involving Contamination with Radioactive Material [PDF 669KB].]

National: Gluten-free must contain less than 20 parts per million
Gluten-free labeling standards kick in
AccessNorthGA.com   (08/05/2014)  
[Editor’s Note: Read the U.S. Food and Drug Administrations’ standards for gluten-free labeling.]

National: Decades after assassination attempt, James Brady’s death rule homicide
Medical examiner rules James Brady’s death a homicide
Washington Post   (08/08/2014)   Peter Hermann and Michael E. Ruane

National: New painkiller combines Oxycodone and Naloxone as abuse-deterrent
New abuse-deterrent painkiller approved by FDA
CNN   (07/24/2014)   Stephanie Smith

National: Military leaders worry obesity epidemic threatens national security
Retired generals back FLOTUS in food fight
Politico   (08/11/2014)   Helena Bottemiller Evich
[Editor’s note: Read this Morbidity and Mortality Weekly Report, Vital Signs: Fruit and Vegetable Intake Among Children: United States, 2003–2010, published August 8, 2014.]

International: Man could be fined up to $4,100 for illegal running of the bulls selfie
Man takes selfie during bull-run festival in Spain
USA Today   (07/14/2014)   Jessica Durando

Constantinos DePountis

Title:
Staff Attorney, Standing Rock Sioux Tribe Legal Department

Education: 
Certificate in Nuclear Propulsion, Naval Nuclear Power School
Bachelor of Science in Human Resources Management, New School University
Certificate in Information Systems, Columbia University
Juris Doctor, University of North Dakota School of Law

PHLN: Please describe your career path. 

DePountis: I was born and raised in Washington Heights, the neighborhood in New York City where my parents settled after emigrating from Greece. Although my first exposure to law was as a clerk in a law firm mail room during my senior year in high school, my pursuit of a legal career did not occur until a couple of decades later. In the meantime, the United States Naval Nuclear Program, in which I served for nine years, was my first employer after high school, followed by General Electric Nuclear Services in Japan for a year. After returning to New York and working as a risk consultant in the engineering department of the Hartford Steamboiler Inspection and Insurance Company for thirteen years, I decided to pursue a law degree.

PHLN: What motivated you to change careers and pursue a law degree?

DePountis: I’ve always enjoyed matters of a technical nature, understanding how and why things work.  Up to that point in my life, my curiosity was focused on machines—the engineering of nuclear reactors, or power generation and electrical distribution systems. That was great and remains interesting to me.  But my curiosities shifted to include the functioning of societies—how do the life trajectories of so many individuals coexist. Law is basically about engineering civility; it is the tool we use to create reasonable, fair frameworks that facilitate daily societal function and the nonviolent resolution of our disagreements. The alternative is living in a world where “whoever has the biggest baseball bat wins.”   

PHLN: You are originally from New York; how did you end up in North Dakota working for the Standing Rock Sioux Tribe?

DePountis: Pursuing a law degree is challenging and expensive, even more so when attempted later on in life. My goal was to acquire a solid legal education at a great value. There was also the desire to experience living someplace different. I lived on the west and east coasts, but never in the Midwest. All things considered, the University of North Dakota School of Law fit the bill. I thought I would get my degree, experience living in a part of the country new to me, and then head out west or back to New York. However, half way through law school I fell in love with North Dakota: the people, the endless sky, the moderate pace of life. I also met my fiancé, who is from South Dakota, in law school, and we decided to take the North Dakota bar exam and explore opportunities in North Dakota. When the Standing Rock Sioux Tribe legal position was advertised, it seemed too interesting to pass up. I interviewed with the tribe’s Judicial Committee and was offered a job. After almost three years, it continues to be a fascinating and fulfilling experience.

PHLN: You are one of three attorneys who essentially make up the Attorney General’s office for the Standing Rock Sioux Tribe. Can you please describe your day-to-day job responsibilities?

DePountis: No two days are alike. My responsibilities include representing the tribe in Tribal court; negotiating, drafting, and reviewing contracts; advising the council and chairman on various legal issues; preparing correspondence to our congressional delegation; and providing legal services to the tribe’s programs, departments, and entities. I’ve also had the pleasure of representing the tribe in proceedings in three states, and in the Virginia Court of Appeals. I look forward to arguing the tribe’s position in a case before the Eighth Circuit Court of Appeals in the next few months.

PHLN: How does your law practice touch on public health law?

DePountis: Part of what we do in-house is draft and revise tribal codes, as well as departmental policies and procedures. The Tribal Health Department recently requested assistance in preparing a tribal health code focused on addressing public health concerns pertaining to infectious diseases.

PHLN: The Standing Rock Sioux Tribe recently requested technical assistance from the Public Health Law Program. Can you please describe the circumstances of that request and the results?

DePountis: There was an increase in infectious disease in the region, and the absence of a health code was a concern. Remedial action was taken, but it was clear some research was necessary to prepare procedures to handle such situations in the future.

PHLN: Can you please describe the impetus and process the tribe is currently undergoing to create a tribal public health code?

DePountis: Tribal Council members, the tribe’s health director, the Standing Rock Indian Health Service CEO, and others attended a regional Tribal Public Health Code Forum, at which representatives from the Great Plains Tribal Chairman’s Health Board, the Northern Plains Tribal Northern Epidemiology Center, the National Indian Health Board, the North and South Dakota Health Departments, and the Centers for Disease Control and Prevention (CDC) provided public health information and technical assistance options. Since then, the tribe has reviewed various existing codes that could serve as starting points for a Standing Rock Health Code. The tribe has also worked with CDC to obtain additional possible code language for a Standing Rock Health Code. The final product will eventually make its way through the Tribe’s Judicial Committee and then the full Tribal Council for approval.

PHLN: What are some of the provisions the Tribe is most concerned with including in the new public health law code?

DePountis: The tribe is primarily concerned with addressing any infectious disease outbreaks in a manner that is responsible to the community, but also culturally sensitive toward the individual. For example, drafting a code provision that mindfully deals with the circumstance in which an individual who would benefit from medical treatment refuses treatment and engages in unsafe practices.

PHLN: What other projects are you currently working on?

DePountis: I’m working with the Tribe’s Indian Child Welfare Act Department on revising its policies and procedures, as well as on a sewer ordinance for the Tribe’s Municipal, Rural, and Industrial Water Department. There are also ongoing cases to monitor in state court proceedings in which the tribe is a party. The “to-do” list is never empty.

PHLN: How has your military and corporate background been an asset in your current position? 

DePountis: It was great to have had the opportunity to travel and work all over the world, learn to appreciate varied viewpoints, and recognize that there is rarely just one “correct” way of doing things.  It’s also nice to feel well equipped to remain focused under pressure—to identify and resolve matters at hand rather than get distracted by tangential details.

PHLN: What do you enjoy most about practicing tribal law?

DePountis: First, the people. The key players of the current administration are focused, conscientious, genuine, and also cool. It’s a pleasure to work with such a group of individuals. Additionally, tribal law is laden with jurisdictional issues, which are technical and interesting. Finally, there is much to be done in Indian Country. At the end of the day, it feels good to be part of a team trying to make things better, even if progress occurs in infinitesimal increments.

PHLN: What advice or insight would you offer other tribes who are interested in writing their own public health code?

DePountis: Begin by identifying the issue and then see what’s out there that addresses the concern.  There is no need to reinvent the wheel every time. There are existing tribal codes, model codes, and also resources at CDC that can help provide code language. These are great starting points for developing a code tailored to the needs of a particular tribe.

PHLN: If you weren’t practicing law, what would you likely be doing?

DePountis: I’d be a bush pilot or something like that. Just get the plane from point A to point B. Maybe I’ll do it for fun someday.

PHLN: Have you read any good books lately?

DePountis: E.H. Gombrich’s “A Little History of the World.” 

PHLN: What activities do you enjoy when you’re not practicing law?

DePountis: I enjoy hiking, riding my motorcycle, and good conversation with my fiancé, friends, and family. 

PHLN: Is there anything you would like to add?

DePountis: On behalf of the legal department, thanks to CDC for the quick response and support.

The first reader to correctly answer the Quiz question will be given a mini-public health law profile in the September 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!  

Public Health Law News Quiz Question: August 2014

With what two organizations did the Public Health Law Program co-host a webinar titled “Ebola and the Law: What you Need to Know” on Tuesday, August 12, 2014?

Bradley Dean

July Question: According to the July 2014 edition of the News, which state recently outlawed “vaportini” devices?
Winning response: Maryland

A brief explanation of your job:
Design training objectives and coordinate different divisions of emergency services continuing education programs to include the Fire, Emergency Management and Emergency Medical Services.  

Education:
Associate degree in emergency medical sciences from Davidson County Community College in Lexington, North Carolina; bachelor of business administration from Catawba College, Salisbury, North Carolina; master of arts from Wake Forest University, Winston-Salem, North Carolina.

Favorite section of the News:
My favorite section of the News is the “Fifty Nifty,” which gives a run-down of all of the different public health laws within the different states and commonwealths. I like to read through them to see how something like this could affect my community locally.

Why are you interested in public health law?
My interest in public health law started in graduate school—looking at the ethical implications and how the laws affect a person in a community. I see public health as an all-embracing enterprise bonded by the common value of societal well-being. With the implementation of public health laws and the field gaining popularity, we hope to see reductions in health disparities among varying populations. As a life-long learner, and the lack of conceptual clarity [in the area of] of public health law as it develops, I will continue to study carefully the legal foundations, its ethical dimensions, and its relationship to human rights.

Do you have any hobbies?
I enjoy reading publications and studies on public health because my professional development is in emergency services. As for real hobbies, I enjoy martial arts, cooking out with family and friends, and occasionally camping and hiking.

Missouri: Fire dep’t lift assists not proprietary and have sovereign immunity
Crouch v. City of Kansas City, Mo.
Court of Appeals of Missouri, Western District
Case No. WD76824
Opinion filed 08/05/2014
Opinion by Judge Karen King Mitchell

New York: State Dept. of Health had authority to regulate and enter into contracts
Concerned Home Care Providers, Inc. v. NY State Dep’t of Health
Supreme Court, Suffolk County, New York
Case No. 015593-2013
Decided 07/29/2014
Opinion by Justice Emily Pines

Ohio: Landowner stung, court denies land’s use for bee keeping
Shamockery LLC v. Olmsted TWP. Bd. Of Zoning Appeals
Court of Appeals of Ohio, Eighth District, Cuyahoga County
Case No. 100858
Released and journalized 07/07/2014
Opinion by Judge Mary Eileen Kilbane

Federal: City’s refrigerants law is reasonable exercise of police powers
Ass’n of Home Appliance Manufacturers v. City of New York
United States District Court, S.D. New York
Case No. 13 Civ 07888 (LGS)
Filed 07/29/2014
Opinion by District Judge Lorna G. Schofield

Federal: Court upholds country-of-origin labels for meat products
Am. Meat Inst. v. USDA [PDF 219KB]
United States Court of Appeals for the D.C. Circuit
Case No. 13-5281
Decided 07/29/14
Opinion by Senior Judge Stephen F. Williams

Federal: Doctors violate patient right to privacy by asking about firearms
Wollschlaeger v. Governor of Fla. [PDF 533KB]
United States Court of Appeals for the Eleventh Circuit
Case No. 12-14009
Filed 07/25/2014
Opinion by Judge Gerald Bard Tjoflat

Constantinos (Dean) DePountis, Staff Attorney, Standing Rock Sioux Tribe Legal Department

"Law is basically about engineering civility; it is the tool we use to create reasonable, fair frameworks that facilitate daily societal function and the nonviolent resolution of our disagreements. The alternative is living in a world where 'whoever has the biggest baseball bat wins.'"