December 2015—Public Health Law News

Legal Epidemiology Journal Article Ahead of Print. The Annual Review of Public Health has published “A Transdisciplinary Approach to Public Health Law: The Emerging Practice of Legal Epidemiology,” by Scott Burris, Marice Ashe, Donna Levin, Matthew Penn, and Michelle Larkin (Volume 37, publication date April 2016). The article describes the transdisciplinary model of public health law, which melds scientific evaluation and legal practices, and the emerging legal epidemiology field.

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Webinar on CDC’s 6|18 Initiative. This webinar, hosted by the Association of State and Tribal Health Officials, will provide a general overview of CDC's 6|18 Initiative and describe the policy collaborative. Rhode Island will describe its success-to-date in implementing one of the targeted interventions (asthma), as well as their collaboration between Medicaid and public health, and what they hope to accomplish by participating in the policy collaborative. The webinar will take place Monday, January 4, 2016, 1:00–2:00 pm (EST).

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Public Health Associates Program Applications. CDC’s Public Health Associates Program (PHAP) is a two-year, on-the-job training program funded by CDC. Associates are assigned to state, tribal, local, and territorial public health agencies, nongovernmental organizations (community-based organizations, public health institutes and associations, and academic institutions), and CDC quarantine stations. PHAP will accept applications for host sites from January 4–22, 2016. PHAP is open to recent college graduates and will accept applications for the 2016 PHAP program from January 4–8, 2016.

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Webinar on Healthcare-Associated Infections. The American Bar Association Health Law Section’s Public Health and Policy Interest Group, along with CDC’s Public Health Law Program (PHLP) and the Department of Health and Human Services’s Office of Disease Prevention and Health Promotion, are offering the last webinar in a three-part series, Healthy People 2020 Law and Health Policy Project: A Focus on Healthcare-Associated Infections, on Monday, January, 25, 2016, 1:00–2:30 pm (EST). This webinar will discuss legal and policy issues about preventing and addressing healthcare-associated infections’ (HAI’s), central line-associated bloodstream infections, and methicillin-resistant Staphylococcus aureus and will describe the legal approaches states and communities have taken to avoid HAIs and improve health outcomes.

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NACCHO Annual 2016. The National Association of City and County Health Officials (NACCHO) will host its annual conference July 19–21, 2016, in Phoenix, Arizona. The theme is “Creating a Culture of Health Equity.” Proposals for sessions and posters must be submitted by Friday, December 18, 2015.

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2016 Public Health Law Conference. The Public Health Law Conference will take place September 15–17, 2016, at the Grand Hyatt, in Washington, DC. The conference, hosted by the Network for Public Health Law, is for public health lawyers, practitioners, officials, policymakers, researchers, and advocates. Conference attendees will learn about laws and policies affecting critical public health issues, such as disease prevention, drug overdose, health data sharing, and access to care. Early bird registration is available now.

PHLP’s Menus of Vaccine Laws. Healthcare facilities across the country are increasingly requiring both healthcare workers and patients to be vaccinated for certain diseases in an effort to reduce outbreaks of vaccine-preventable diseases. In some instances, facilities are establishing these requirements due to mandates in state statutes and regulations.

• Menu of State Hospital Pneumococcal Vaccination Laws. An inventory of state laws that establish pneumonia vaccination requirements for hospital healthcare workers and patients.
• Menu of State Hospital Influenza Vaccination Laws. An inventory of state laws that establish influenza vaccination requirements for hospital healthcare workers and patients.

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New Outpatient Policy Options. CDC’s National Center for Emerging and Zoonotic Infectious Diseases and the Division of Healthcare Quality Promotion published Outpatient Settings Policy Options for Improving Infection Prevention in October 2015. The document is designed to help state, local, and territorial health departments and policy makers at various levels analyze current policies in outpatient settings, review proposed changes, and inspire possible changes to improve programs.

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New Public Health Law Datasets. Public Health Law Research released one new and one updated legal dataset.

• Mold Remediation and Certification Laws Map. This new dataset, published to LawAtlas.org, details state mold remediation laws and the training and certification laws for mold remediation workers.
• Nurse Practitioner Prescribing Laws Map. This recently updated dataset now includes laws on prescribing authority for nurse practitioners in all 50 states. It has been updated through October 31, 2015.

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NACCHO Public Health Blogs. NACCHO hosts two blogs that could be helpful for people seeking information on public health law topics. The NACCHO Preparedness blog offers emergency preparedness and legal preparedness resources, while the Healthy People, Health Places blog offers essential information about local public health.

Syrian Refugees in Texas
The Atlantic   (12/7/2015)   Krishnadev Calamur

Twenty-one Syrian refugees were to arrive in Texas during the week of December 7, 2015, despite Texas’s lawsuit against the federal government and a refugee-resettlement agency. In the suit, Texas argues that the federal government is required to consult with governors and mayors before relocating refugees under the Refugee Act of 1980. Legally, all refugees fall under immigration policy, which is exclusively delegated as a federal power under the US Constitution. In the past, this federal power has been used to strike down state actions against immigrants that conflict with federal immigration laws.

Texas’s challenge to the Refugee Act of 1980 is based on language within the act requiring the federal government to “consult regularly (not less often than quarterly) with State and local governments and private nonprofit voluntary agencies” about the sponsorship and distribution of refugees “before their placement in those states and localities.”

Texas’s actions to block Syrian refugees from resettling began three days after the Paris terrorist attacks on November 14, 2015. At least one of the attackers in Paris carried a Syrian passport, which was later found to be counterfeit. Due to the huge numbers of refugees fleeing Syria, after almost five years of brutal civil war, false Syrian passports have become increasingly common.

The United States has taken in fewer than 2,000 Syrian refugees so far, of which 238 have been resettled in Texas. The number of Syrian refugees resettled in the United States is expected to increase to 10,000 in 2016.

[Editor’s note: Learn more about the US Department of State’s refugee admissions and CDC’s guidelines for pre-departure and post-arrival medical screening and treatment of US-bound refugees.]

California: 2 states to allow access to birth control without physician’s prescription
Becker’s Hospital Review   (11/23/2015)   Emily Rappleye
[Editor’s note: Read California’s SB 493 and Oregon’s HB 3343.]

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Hawaii: Plenty of sun and sand, but no sovereignty in Hawaii
Chicago Tribune   (12/03/2015)   Noah Feldman

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Illinois: Chipotle E. coli case in Illinois: Officials mum on details
Chicago Tribune   (12/07/2015)   Samantha Bomkamp
[Editor’s note: Learn more about E. coli.]

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New York: High-salt warning on New York [City] menus to start Tuesday
New York Times   (12/01/2015)   Daniel Victor
[Editor’s note: Learn more about the New York City Department of Health and Mental Hygiene’s sodium initiatives.]

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Drug makers buy pricey vouchers to speed products to market
Wall Street Journal   (11/01/2015)   Peter Loftus
[Editor’s note: Learn more about the U.S. Food and Drug Administration’s Rare Pediatric Disease Priority Review Voucher Program.]

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National: Ebola crisis passes, but questions on quarantines persist
New York Times   (12/03/2015)   Sheri Fink
[Editor’s note: Learn more about state Ebola protocols.]

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National: Gun violence is an epidemic. It is time for a public health response
The Guardian   (12/04/2015)   Georges Benjamin

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National: Justices urged to save state health databases
Bloomberg   (12/01/2015)   Jacklyn Wille

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National: The year ahead, Part I—Pot, alcohol, and opioids among 2016 hot issues
State Net Capitol Journal   (12/7/2015)   Rich Ehisen

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International: Beijing issues red alert over air pollution for the first time
New York Times   (12/07/2015)   Edward Wong

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International: How a conservative-lead Australia ended mass killings
New York Times   (12/4/2015)   Austin Ramzy, Michelle Innis, and Patrick Boehler

Interview with Joe Finn, Director of the Massachusetts Housing and Shelter Alliance, Boston, MA

Title: President and Executive Director of the Massachusetts Housing & Shelter Alliance, Boston, Massachusetts; City Councilor, City of Quincy, Massachusetts

Education: Joe Finn is a 1978 graduate of Siena College. He earned a Master of Arts degree in Theology from the Washington Theological Union, a master of arts degree in sociology from the New School for Social Research, a j uris doctor from the New England School of Law, and an honorary doctor of humanities from Bentley College.

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Public Health Law News (PHLN): What drew you to work to address homelessness?

Finn: I was in the Franciscan Order from 1978 to 1989, and my Franciscan formation and the values acquired during my time as a friar led me to become deeply engaged in issues of poverty and service to the poor. When I made the decision to leave the Order, it made sense to me to continue in that direction. My interest in recovery gave me a special commitment to working with people who struggle with substance use disorders. I always felt we could do more for such people than simply warehousing them in mass shelters.

PHLN: Why is homelessness a public health problem?

Finn: Homelessness represents total systems failure in our society, especially within health care. Society’s lack of focus on the social determinants of health means that we attempt to provide health interventions to people living on the streets instead of working toward a true model of integrated care that serves those people in housing. As a result, we spend exorbitant amounts of dollars on interventions that are not successful, exhausting critical resources while the health issues of this vulnerable population continue to be exacerbated.

PHLN: Can you please describe your career path?

Finn: In 1990, I left the Order and began working in homeless services. I worked for the Long Island Shelter System, Positive Lifestyles, Father Bill’s Place (Quincy Interfaith Sheltering Coalition, now Father Bill’s & MainSpring), and Shelter, Inc. (now Heading Home). I finally joined Massachusetts Housing and Shelter Alliance (MHSA) as executive director in 2003, and I have been here ever since. In 1997, I graduated after four years from the New England School of Law. I was elected in 2001 to the City Council of Quincy, Massachusetts, and I continue to serve in that capacity.

PHLN: What is MHSA?

Finn: MHSA is a member-based advocacy and policy organization that promotes innovation and resource development aimed at ending homelessness by reducing Massachusetts’s reliance on emergency resources. We are not a trade association—we do not exist for our members’ institutional well-being. Instead, we work with our 100 member agencies to advocate at the local, state, and federal levels for policy and practice to end homelessness by developing strategies that address homeless people’s intertwined and unmet healthcare, income, and housing needs. We are also an intermediary of both public and private resources dedicated to innovative solutions to homelessness.

PHLN: Please describe your position’s day-to-day work responsibilities.

Finn: I am the CEO of our organization and its primary advocate. I help shape both our policy and pragmatic responses to the homelessness issue. As CEO, I’m responsible for board management, fundraising, and day-to-day operations. A big part of my job focuses on vision and innovation to promote outcome-based programming by MHSA members.

PHLN: What is homelessness?

Finn: Homelessness is the lack of safe, permanent, affordable housing or living under circumstances considered uninhabitable for humans.

PHLN: Do you consider your job “practicing public health law”? Why or why not?

Finn: Although my law degree has been useful from an administrative law and policy perspective, my work is far too broad to be considered “practicing public health law.” Yet, my experience in the field has highlighted for me the value that public health lawyers bring to conversations about healthcare reform and alternative payment models. The complexity of these issues requires the input of public health lawyers dedicated to unpacking the legal implications of healthcare reform.

PHLN: What motivated you to become an attorney, and how do you use your degree?

Finn: I have an advanced degree in sociology, and I’ve always been interested in the intersection of social problems and policy. In our society today, the language of policy is law, and it was clear to me that a law degree would be helpful in understanding such issues. I use my law degree today mostly in dealing with governmental entities and unpacking their language related to various initiatives meant to serve people experiencing homelessness.

PHLN: Are there specific legal or other challenges unique to people suffering from homelessness?

Finn: I think the specific challenge before us in Massachusetts is the further development of healthcare reform and alternative payment models. How do you structure integrated care for people who do not know where they’ll sleep that night? Under the healthcare system’s old fee-for-service model, we’ve been able to create unique and effective models to support housing for chronically homeless people. As we move toward the development of accountable care organizations or other alternative payment models, we’re monitoring whether these alternative payment models will affect the availability and quality of the integration of health care and housing for homeless people. Both understanding and helping to structure regulatory and practical responses to these questions are quite challenging. We’re also concerned about the criminalization of homelessness and the emergence of local ordinances that affect homeless people.

PHLN: What are emergency homelessness resources?

Finn: In addition to the massive shelter system, emergency resources represent those services and facilities affected by a person’s homelessness—including emergency room costs, detox services, ambulance and emergency calls, public safety costs, and repetitive acute medical stays.

PHLN: Do emergency resources address homelessness effectively? Why or why not?

Finn: Although emergency resources might save someone’s life, if they don’t address the core issue—lack of housing—they could only perpetuate the problem. Housing is the only resource that has sufficient stabilizing impact to help a person experiencing long-term homelessness.

PHLN: What are low-threshold permanent supportive housing and compliance-based housing models?

Finn: Compliance-based models begin with the presumption that no one can live permanently within housing without “fixing” the problems that made them homeless—for example, remaining abstinent from alcohol and drugs, taking psychiatric medications, following house rules, and meeting with case managers. Low-threshold permanent supportive housing changes this paradigm and focuses instead on holding tenants to the responsibilities of an ordinary tenant. We don’t kick people out of housing for manifesting their illnesses or disabilities. We surround units with the appropriate services and intervene when necessary, but we focus instead on supporting positive tenancies. I like to say we’ve taken the focus off requiring individuals to be good clients; instead, we changed it to supporting people in being good tenants. This shift is grounded in a strong conviction about the stabilizing impact of housing.

PHLN: What makes low-threshold permanent supportive housing a more effective long-term response to homelessness?

Finn: The key is our focus on successful tenancies. We’ve found low-threshold permanent supportive housing far more successful than the standard responses in keeping people housed and out of homelessness. I think this might be because the model relies much more on an individual person’s goals and respect for their dignity and autonomy. Our Home & Healthy for Good (HHG) initiative, which provides permanent supportive housing for chronically homeless people, has demonstrated that low-threshold housing leads to both an increased quality of life for tenants, as well as tremendous savings in healthcare costs.

PHLN: Massachusetts has been hailed as a leader in addressing homelessness. Why is addressing homelessness a priority there?

Finn: Massachusetts, to its credit, has maintained a sense of responsibility for those in need. I believe that homelessness represents a failure of systems to meet the needs of a significant number of residents and as such represents an affront to our core values and image of who we are as a Commonwealth. It’s very costly to let homelessness continue without trying to address it.

PHLN: Can you describe some of Massachusetts’s programs aimed at addressing homelessness?

Finn:  MHSA’s HHG initiative, mentioned above, has been at the forefront of the Housing First movement in Massachusetts since 2006. HHG continues to demonstrate that providing housing and supportive services to chronically homeless people through a low-threshold, Housing First model is less costly and more effective than managing their homelessness and health problems on the street or in shelters. MHSA has been recognized nationally for our work with the Massachusetts Behavioral Health Partnership to develop the Community Support Program for People Experiencing Chronic Homelessness (CSPECH), a proven model of Medicaid reimbursement that can help fund permanent supportive housing for chronically homeless people. In addition to initiatives like HHG and CSPECH, which are focused on supporting chronically homeless people in housing, MHSA works with our member agency HomeStart to operate a Rapid Re-housing Program to help people experiencing short-term homelessness move quickly from emergency shelters or the streets into housing. MHSA’s member agencies operate a number of other programs that provide critical support for people moving out of homelessness, including HomeStart’s aggressive housing search program and Pine Street Inn’s IMPACT Employment Services.

PHLN: Can you describe Massachusetts’s social impact bonds for homelessness?

Finn: In a nutshell, MHSA is engaged with the Commonwealth in a Pay for Success contract. This program will place more than 500 people in permanent supportive housing by relying on private investment and repurposed public dollars (primarily Medicaid resources through MassHealth for services). Private investors have financed a portion of the cost and will be paid back if the program results in successful tenancies. A key accomplishment of the initiative is that MHSA’s advocacy has resulted in the expansion of CSPECH (mentioned above) to additional Managed Care Entities in Massachusetts. The expansion of CSPECH means that more chronically homeless individuals will have access to Medicaid-reimbursed supportive services in permanent housing.

PHLN: What initiatives have been successful in the past?

Finn: In addition to the programs mentioned above, another successful initiative in Massachusetts had been the Individual Self Sufficiency Initiative (ISSI). This was a shallow subsidy program to work with transitory, short-term homeless persons to move them out of shelters as quickly as possible. This is very similar to our rapid re-housing initiatives of today. Unfortunately, ISSI was lost around 2002 in a period of extensive state budget cuts.

PHLN: When thinking about and addressing homelessness, what should people and organizations keep in mind?

Finn: The status quo is very expensive. Addressing the issue of homelessness and actually ending it has long-term, positive benefits for us all.

PHLN: How can people get involved and help end homelessness?

Finn: Ending homelessness requires the support of people from all walks of life—service providers, policymakers, foundations, corporations, community groups, and individuals. The first step is education—learning about homelessness in your community and current efforts to implement long-term solutions to homelessness. The key here—whether you’re volunteering with a local organization, advocating for policy changes, or donating to support housing initiatives—is thinking critically and asking questions to ensure that you’re investing in innovative, outcome-based strategies that actually focus on ending homelessness.

PHLN: What do you like about your job?

Finn: I like addressing the systemic issues that create poverty. I like working toward building a “better mouse trap.” I’ve seen many miracles result from the stabilizing impact of housing. This creates a real sense of satisfaction that what I’m doing is worthwhile.

PHLN: If you weren’t working at MHSA, what would you be doing?

Finn: I would probably be more deeply engaged in electoral politics of some sort, or I would be a full-time lacrosse coach!

PHLN: Have you read any good books lately?

Finn: Plato at the Googleplex: Why Philosophy Won’t Go Away by Rebecca Goldstein

PHLN: What are your hobbies?

Finn: The sport of lacrosse. I have been very deeply involved in promoting and coaching the sport of lacrosse in my community.

PHLN: Is there anything you would like to add?

Finn: When it comes to ending homelessness, we know what works—we know that evidence-based models like rapid re-housing and low-threshold permanent supportive housing are effective in ending homelessness. The challenge now is for us to bring these programs to scale. It’s a challenge that will require support from both the public and private sector, but it’s a challenge that we can accomplish. We can’t afford not to take action.

The first reader to correctly answer the quiz question will be given a mini public health law profile in the December 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: December 2015

What sport is one of Joe Finn’s hobbies?

Dr. Deborah Loveys

November Question: Dr. Ashley Tuomi is the president-elect of what national organization?

Winning response: 
Ashley Tuomi is the President-elect of the National Council of Urban Indian Health

Employment organization and job title: Scientific Program Officer, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (serving the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, the National Center for Immunization and Respiratory Diseases and the National Center for Emerging and Zoonotic Infectious Diseases), Extramural Research Program Office, Centers for Disease Control and Prevention (CDC).

Brief job description: I’m an extramural research scientist and program officer for grant and cooperative agreement research awards funded through the infectious disease centers at CDC. I monitor post-award actions for grants and cooperative agreement research public health awards and assist CDC’s Procurement and Grants Office in the development, publication and administration of funding opportunity announcement awards.

Education: PhD and MS, University of Maryland; post-doctoral fellowships in pediatric hematology and respiratory viral disease at Johns Hopkins School of Medicine and the Food and Drug Administration.

Favorite section of the News: All the sections are excellent. I love to review “Briefly Noted” followed by “Legal Tools” and “Top Story.”

Why are you interested in public health law? I’m interested in public health law because it touches all of us, in so many different ways, at some-time or another. From a professional capacity as a grants program official, historical and new judicial decisions and legislative processes guide and define how the federal government can fund basic and applied public health research.

What is your favorite hobby? Of my hobbies, building wooden boats is my favorite. I have built a 17 ft. ocean kayak and also an 8 ft. wooden SKUA (#96-The Sazerac) that I travel to Cocktail Class Wooden Boat Racing Association regattas across the east coast.

California: Consideration or remedial action plan in good faith settlement harmless
Dole Food Company, Inc. v. Superior Court of Los Angeles County, California
Court of Appeals for California, Second District, Division Three
Case No. B262044
Filed 12/2/2015
Opinion by Justice Lee Smalley Edmon

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Massachusetts: Closing correctional facility’s purification lodge violates the Religious Land Use and Institutionalized Persons Act of 2000
Trapp v. Roden
Supreme Judicial Court of Massachusetts, Worcester
Case No. SJC-11863
Filed 11/23/2015
Opinion by Justice Fernande R.V. Duffly

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Oklahoma: Concurrent jurisdiction for certain zoning issues related to oil industry
In re Ritze
Oklahoma Attorney General’s Opinions
Case no. 2015 OK AG 12-2015
Decided 11/30/2015
Opinion by E. Scott Pruitt, Attorney General of Oklahoma and Ethan Shaner, Assistant Attorney General

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Pennsylvania: Surrogate mother had no biological or legal claims to the child
In re Baby S., Appeal of S.S.
Superior Court of Pennsylvania
Case No. 1259-EDA 2015
Filed 11/23/2015
Opinion by Judge Susan Peikes Gantman

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Federal: Plaintiff’s compounded medications negligence claims sound in medical malpractice under the Connecticut Products Liability Act
Gallinari v. Kloth et. al
The United States District Court for the District of Connecticut
Case No. 3:15-cv-00872 (VAB)
Filed (12/1/2015)
Opinion by Judge Victor A. Bolden

Quotation of the Month: Georges Benjamin, Executive Director of the American Public Health Association

“We’re not debating the constitutionality of guns. What we want to do is work to make people safer with firearms, the firearms themselves safer and our society safer with firearms in the environment.” Georges Benjamin, executive director of the American Public Health Association on why gun violence should be considered and treated as a public health crisis.