September 2015—Public Health Law News

Webinar Series on the Intersection of Public Health and Health Care—The Role of Law. The American Health Lawyers Association and the Public Health Law Program (PHLP) are co-hosting a six-part, free webinar series focused on legal issues at the intersection of public health and health care. The fourth webinar in the series Implementing the ACA—Community Health Needs Assessments, will take place Friday, September 18, 2015, 1:00–2:30 pm (EDT). This webinar will describe federally qualified health centers and rural health clinics and give practical insight into the field.

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FDA Seeks Comments on Proposed Nutrition Labeling Changes. The FDA issued two proposed rules and one supplemental proposed rule on updating the Nutrition Facts label. The rules are published in the Federal Register so the public can review them and send comments to the FDA. The FDA will consider comments on the original proposed rules and supplemental proposed rule before issuing a final rule. Comments are due October 13, 2015.

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Association of Healthcare Emergency Preparedness Professionals (AHEPP). A new professional association dedicated to advancing the field of disaster preparedness and response, AHEPP is accepting members and hosting their first national conference. The conference will help guide participants through the most important disaster concerns in various types of healthcare facilitates and will be on November 17–18, 2015, in Omaha, Nebraska. See AHEPP’s website for the complete conference agenda, and more information. National Preparedness Month discount ends September 20, 2015,

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Special Ethics Pre-Conference Session at the 143rd Annual Meeting of the American Public Health Association. The APHA Learning Institute is offering a course for public health professionals, LI1005 Good Decision Making in Real Time: Practical Public Health Ethics for Health Officials, at the 2015 Annual APHA meeting. The ethics session will take place October 31, 2015, 9:00 am–5:00 pm CST in Chicago, Illinois. It will introduce the basics of public health ethics and engage participants in discussion of case studies on issues public health officials are likely to face. Contact Drue Barrett at DBarrett@cdc.gov or 404-639-4690 for more information about the course. APHA’s 2015 Meeting will take place October 31–November 4, 2015.

Menu of Selected Tribal Motor Vehicle Safety Laws. [PDF 409KB] An inventory of select tribal laws related to motor vehicle safety. This menu, published by PHLP, informs tribal public health practitioners, policy makers, and attorneys about tribes’ use of law as a tool to address motor vehicle-related injuries.

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Public Health Emergency Preparedness Clearinghouse. The Public Health Emergency Preparedness Clearinghouse is a central repository for emergency preparedness-related statutes, regulations, orders, reports, and legal tools. Created and hosted by PHLP, the Clearinghouse is intended to help jurisdictions consider updates and clarifications to their public health emergency legal preparedness activities.

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Tools and Resources—State Strategies to Improve Health and Control Costs. CDC, in partnership with the National Governors Association and the Center for Medicaid and CHIP Services, has recently developed tools and resources on state strategies to improve health and control cost that will provide public health stakeholders, governors’ offices, and Medicaid directors with specific, evidence-based population health strategies that can be integrated into healthcare delivery systems to improve health outcomes and reduce the cost of care within five years. The resources give statistics about the health burden and information about the economic costs associated with improving tobacco control, improving asthma control, and preventing tooth decay.

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CDC Community Health Improvement Navigator (CHI Navigator). The CHI Navigator is a website for people who lead or participate in community health improvement work within hospitals and health systems, public health agencies, and other community organizations. It’s a one-stop-shop that offers community stakeholders expert-vetted tools and resources about the process of identifying and addressing communities’ health needs.

Ten years after Hurricane Katrina: progress and challenges remain for US emergency preparedness
Health Affairs Blog   (08/27/2015)   Nicole Lurie, Karen DeSalvo, and Kristen Finne

In August 2005, Hurricane Katrina, closely followed by Hurricane Rita, devastated the City of New Orleans and parts of Western Louisiana. These storms and the destruction they created have become synonymous with systemic disaster preparedness failure, encouraging officials, government agencies, politicians, community agencies and stakeholders to reassess their emergency preparedness and response plans. Ten years after the storms, progress has been made, but significant challenges remain.

When Hurricane Katrina struck the Gulf Coast, many healthcare facilities in the area didn’t have plans and resources to care for their patients, were unable to evacuate patients, and, due to communication system failures, were cut off from external entities that might have provided aid. These types of issues were exacerbated by slow or uncoordinated responses from federal and state agencies.

In the wake of these storms, Congress created the Office of the Assistant Secretary for Preparedness and Response (ASPR), which is part of the US Department of Health and Human Services (HHS). In addition to providing guidance and supporting health preparedness programs, ASPR coordinates the federal medical and public health aspects of HHS and US government response during disasters.

Also, in response to the poorly integrated systems and mechanisms for a cross-jurisdictional response in the Gulf at the time of the storms, the National Health Security Strategy (NHSS) was created. The NHSS recognizes how vital coordination on the part of all stakeholders, both governmental and non-governmental entities, is to disaster response. NHSS includes the National Health Security Strategy and Implementation Plan and the National Health Security Review, which seek to strengthen communities’ ability to “prevent, protect against, mitigate the effects of, respond to, and recover from disasters and emergencies,” and evaluate the progress and challenges related to national health security, respectively.

Hurricane Sandy, which hit New York City in 2012 and was the largest national disaster in the United States since Hurricane Katrina, is a good example of how these organizations and others have worked to improve national emergency response and health preparedness. Although the response was not perfect, teams responding to sandy reacted in hours, rather than days. Even with the improvements that have been made, there is still a lot of work to be done in the area of emergency preparedness. Officials, communities, federal and state agencies, and individuals must fight complacency and not lose focus by continuing to improve public health emergency planning and preparedness.

[Learn more about ASPR, NHSS, and how law can be used to improve emergency preparedness.]

California: Are traumatized students disabled? A debate straight outta Compton
NPR   (08/20/2015)   Cory Turner

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Louisiana: Blighted houses still mar New Orleans a decade after Katrina
Reuters   (08/23/2015)   Kathy Finn

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Massachusetts: Boston bans chewing tobacco in ballparks, including Fenway
The Boston Globe   (09/02/2015)   Felice J. Freyer        

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New Jersey: Judge approves NJ-Exxon settlement
The Wall Street Journal (08/25/2015)   Kate King

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Texas: Public employees to be given provisions for pumping breast milk at work
The Dallas Morning News   (08/28/2015)   Brittney Martin
[Editor’s note: Read Texas H.B. 786, which took effect September 1, 2015.]

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Washington: Nation’s largest gun rights groups team up for first time to sue Seattle over tax
The Washington Free Beacon   (09/02/2015)   Stephen Gutowski
[Editor’s note: Learn more about Seattle’s measures to address gun safety.]

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National: FDA warns 5 producers of powered caffeine
New York Times   (09/01/2015)   Sabrina Tavernise
[Editor’s note: Read the FDA’s warning letters.]

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National: Strict state gun laws could lead to drops in suicide, study says
CNN (09/02/2015)   Carina Storrs
[Editor’s note: Learn more about the study and read Effects of changes in permit-to-purchase handgun laws in Connecticut and Missouri on suicide rates, by Crifasi, Cassandra K., John Speed Meyers, Jon S. Vernick, and Daniel W. Webster, published in Preventative Medicine, October 2015.]

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National: The government’s surprisingly detailed description of what qualifies as mayonnaise
The Washington Post   (08/26/2015)   Brady Dennis

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National: Widespread speed cameras could save thousands of lives, new study finds
Yahoo News   (09/01/2015)   Justin Hyde
[Editor’s note: Learn more by reading the Insurance Institute for Highway Safety study, Effects of Automated speed enforcement in Montgomery County, Maryland, on vehicle speeds, public opinion, and crashes, by Hu, Wen, McCartt, Anne T., published by the Insurance Institute for Highway Safety, August 2015.]

Interview with Tina Batra Hershey, JD, MPH

Title:
Assistant Professor, Health Policy and Management Department
Assistant Director for Law and Policy, Center for Public Health Practice
University of Pittsburgh Graduate School of Public Health

Education:

BA, cum laude, Psychology, Villanova University
JD, with honors, The George Washington University Law School
MPH, Health Policy, The George Washington University School of Public Health and Health Services (now the Milken Institute of Public Health)

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Public Health Law News (PHLN): Please describe your career path.

Hershey: I practiced health law in Washington DC and Pittsburgh for a number of years before entering academia. While in private practice, I worked for law firms that specialized in health law, so I was really able to immerse myself in the field. I left the workforce for a few years to stay home with my children, but I remained connected as a year-in-review editor for the American Health Lawyers Association and practicing health law part-time. Once my kids were a little older, a friend mentioned that the Graduate School of Public Health (Pitt Public Health) at the University of Pittsburgh was looking for lawyers for research projects, so I became a legal analyst at the Center for Public Health Practice (CPHP) at Pitt Public Health. I started teaching Health Law and Ethics a few years later and became an assistant professor.

PHLN: Were you always interested in public health law? What sparked your interest?

Hershey: I’ve always been interested in health care; in fact, I was pre-med for a few years in college. I decided early in law school to specialize in health law by getting a joint JD/MPH. My expansion into public health law came from the opportunity to work at CPHP. 

PHLN: Please describe your day-to-day work responsibilities.

Hershey: A typical day would involve legal research and writing related to current and future projects, advising students, preparing for class and/or lecturing, attending meetings, and planning for my next public health emergency law training.  I really enjoy interacting with students and have found that I love teaching health law.    

PHLN: How did you become involved in public health emergency law?

Hershey: I was hired at CPHP to provide legal analysis for a National Institutes of Health-funded computational modeling project: Models of Infectious Disease Agent Study (MIDAS). This was during the H1N1 outbreak in 2009, so public health emergency law was a hot topic. In addition, I became the project director for a CDC-funded public health law training project designed to prepare judges to address cases involving public health emergencies. Being involved in that training project taught me a lot about public health emergency law.

PHLN: What role does law play in effective public health emergency response?

Hershey: It’s an effective tool to address many public health issues, including emergency response. Public health officials need to understand what authority they have in order to prepare for and respond to public health emergencies, because the law is used in virtually every aspect of emergency response, including disease surveillance, restrictions on movement (e.g., isolation, quarantine), resource allocation, and emergency declarations. At the same time, the law needs to be used appropriately so there’s a balance between people’s rights and communities’ protection, which is where judges enter the picture.

PHLN: How and when did you begin training judges for public health emergencies?

Hershey: I started preparing judges for public health emergencies in 2010 when I became project director for the program started by my former colleague, Patricia Sweeney, Public Health Law and Science: A Seminar for Judges. I became the principal investigator for the project in 2013.

PHLN: Why are judges an important part of public health emergency response?

Hershey: Judges are important because it’s their job to balance people’s rights with the need to protect the public’s health when they decide which public health policies to enforce. They need to understand not only the law, but also the nature and extent of the threat to public health. And they need to make quick decisions. Judges’ importance was really demonstrated last fall in the case of the Ebola quarantine order for a nurse returning from treating patients in West Africa. In making a decision about how to enforce the order, the judge looked at the characteristics of the disease, asked the right questions and in the end decided to enact a less restrictive order that allowed the nurse more freedom but still took precautionary measures to protect the public’s health.

PHLN: How many trainings have you given to-date and where?

Hershey: Thirteen trainings have been held thus far, with two more scheduled in 2015. Judges in 14 states have been educated about public health and emergency response law; they also learned about the science of epidemiology and disease transmission. We’ve held three tribal-focused trainings. The tribal trainings have expanded beyond judges to include tribal public health practitioners and emergency managers. We also have had public health practitioners and attorneys attend the judicial trainings in some states.

PHLN: What kind of public health emergency issues might a judge adjudicate?

Hershey: Public health emergencies often involve infectious diseases and the prevention of outbreaks. A classic example is a hearing related to someone who is non-compliant with treatment for tuberculosis. A health department will turn to the courts after someone refuses to follow health department directives related to treatment and restrictions on movement. Issues can also arise after natural disasters, such as floods or wildfires, as legal challenges may be brought to protest government actions after an emergency declaration. Judges can also be involved if there is a challenge to a government’s use of private property during an emergency response.

PHLN: What kind of judges attend your trainings and what’s included in the course?  

Hershey: The training is geared toward all levels of state court judges who may have jurisdiction over public health cases. The course includes both legal and scientific information because it’s crucial for the judges to understand the science behind disease transmission so they can make informed decisions. On the legal side, we cover federal- and state-specific law related to emergency declarations, quarantine, and other restrictions on movement, mandatory treatment and examination, and privacy issues. We also address the practical and procedural issues courts will face in emergencies, such as video hearings, protection of others in courtrooms, and due process concerns. 

What’s really great about this training is that local public health officials, local professors, and local public health practitioners provide the content. So not only do participants receive information relevant to their interests, they also make connections in the community that will be useful in the event of an emergency.

PHLN: Why might judges need this training in addition to their legal education and experience? 

Hershey: Most judges have never dealt with the issues that arise in public health cases, and many are not aware of the role judges may play in public health emergencies. This training program is designed to bridge that gap and ensure that judges are prepared before a public health emergency strikes.

PHLN: Has the training evolved over time? If so, how?

Hershey: Yes, in fact we recently revised and renamed the training Preparing for Public Health Emergency: A Law and Science Workshop. In addition, while we have a “core” curriculum, each training is tailored to the jurisdiction involved, whether state or tribal. We also make changes after each workshop to incorporate different training techniques and/or topics, as well as lessons learned from the previous trainings. Also, each jurisdiction decides the length of the program. It can be as long as two days or as short as an afternoon.

PHLN: What are the most important lessons you’ve learned while practicing and teaching health law?

Hershey: One lesson I have learned is how important it is for non-lawyers to understand how our legal system works and the impact the law has on the delivery of health care services, as well as the health of the population as a whole. The law (and lawyers) are often misunderstood and mistrusted and providing a legal background for non-lawyers will help to change that attitude.

Another lesson is that so much can be learned by studying history and past experiences. Understanding prior events can really help solve current problems.

PHLN: What do you like about practicing health/public health law?

Hershey: I’ve always loved the dynamic nature of health law. I like to learn new things and being involved in health/public health law means that I am constantly learning. In addition, health/public health law are comprised of so many topics that I am never bored.

PHLN: What advice would you give to attorneys and judges who are interested in learning more about public health emergency law?

Hershey: Attend one of my trainings! There are also great resources available from PHLP, the National Association of County and City Health Officials, and the Association of State and Territorial Health Officials about public health emergency law. 

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

Hershey: I’d probably go back to practicing health law, particularly healthcare compliance. 

PHLN: Have you read any good books lately?

Hershey: I just started The Quartet by Joseph Ellis, which is about how the 13 colonies formed the United States of America after the American Revolution. So far, it’s really interesting.

PHLN: What are your hobbies?

Hershey: I enjoy reading, baking, and traveling. I just got back from a trip to Yellowstone and Grand Teton National Parks with my family, and I’m already thinking about where we’ll go next!

PHLN: Is there anything you’d like to add?

Hershey: This is an exciting time in health/public health law, as we are really at a crossroads in the American health system and government’s role in the health of all Americans. In addition, preparedness remains an important issue, particularly in relation to emerging diseases and natural disasters that are the result of climate change and our global world. I feel very fortunate to be doing what I’m doing right now and want to thank Public Health Law News for the opportunity to answer questions.

The first reader to correctly answer the quiz question will be given a mini public health law profile in the October 2015 edition of the News. Email your entry 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: September 2015

What month is National Preparedness Month?

Perrianne Lurie, MD, MPH, FACPM

July Question: Name one of the four questions John Bilderback encourages community organizers to ask themselves before implementing changes similar to the open policy agreement that Step ONE helped implement in Chattanooga-Hamilton County, Tennessee.

Winning response: 
Why is the change we want necessary, and will it help people?

Employment organization and job title: I work for the Bay Mills Health Center, Brimley Michigan, as the quality improvement/risk manager.

A brief explanation of your job: We are a federally qualified health center and tribal health center offering medical, dental, pharmacy, and behavioral health services to Chippewa County and surrounding area. We target the uninsured and under insured population but will provide services to anyone who comes in.    

The essential functions are to oversee and monitor the quality improvement program that are part of the strategic health plan to achieve high impact and significant improvements in the organizational performance. I do the data analysis from our electronic health records to help increase population health. The data are there and we are following evidence based clinical performance measures.

My current job functions are helping reinforce the environmental Health work did in the previous 20 years. I am seeing how environmental changes impact health and it’s very interesting. We have changed the environment to almost require a vehicle and its impacting our health.

Why are you interested in public health law? My interest in public health stems from seeing some people live much longer and others living a shorter, unhealthy life. I enjoy being with and seeing people live a healthy life where they can enjoy running, swimming, hiking, and any physical activity.        

What is your favorite hobby? My general hobbies are outdoor activity, and I guess the one I enjoyed for the past couple years is taking a piece of land, cutting the trees down, hauling them to a portable sawmill, cutting lumber, and building a house that I hope to be living in 2016.

New Jersey: Judge approves $225 million settlement over contaminated Exxon Mobil site
New Jersey Dep’t of Envt’l Protection v. Exxon Mobil Corp. [PDF 464KB]
Superior Court of New Jersey, Union County, Law Division
Docket Nos. UNN-L-3026-04, consolidated within UNN-L-1650-05
Filed 08/25/2015
Opinion by State Superior Court Judge Michael Hogan

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New York: Court has no legal authority to require provider to accept whatever payment the insurer deems appropriate
Unitedhealthcare Servs., Inc. v. Asprinio
Supreme Court, Westchester County, New York
Case No. 58353/15
Decided 08/31/2015
Opinion by Justice Alan D. Scheinkman

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Illinois: Expert may testify using “every exposure theory” in regards to plaintiff’s asbestosis claims under state’s “frequency, regularity, and proximity rule”
Bell v. ABB Group, Inc.
United States District Court, Southern District of Illinois
Case No. 13-cv-1338-SMY-SCW
Filed 09/02/2015
Opinion by District Judge Staci M. Yandle

Quotation of the Month: Adrian Lund, president of the Insurance Institute for Highway Safety

"Speed cameras get drivers to ease off the accelerator, and crashes are less likely to be deadly at lower speeds. This study connects the dots to show that speed cameras save lives,” said Adrian Lund, president of the Insurance Institute for Highway Safety of their study, Effects of Automated speed enforcement in Montgomery County, Maryland, on vehicle speeds, public opinion, and crashes.