January 2016—Public Health Law News

Summer 2016 Internships and Externships with CDC’s Public Health Law Program (PHLP). PHLP is accepting applications for summer 2016 internships and externships, which offer entry-level experience for rising and current 3rd year law students who are interested in exploring careers in public health law. PHLP’s public health lawyers and analysts work to advance the use of law as a public health tool. PHLP provides services and resources, such as technical assistance, publications, and workforce development to CDC programs and state, tribal, local, and territorial health departments. The program is open only to rising and current 3rd year law students. Applications for summer 2016 are due by midnight (EST), February 28, 2016.

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Emergency Declarations and Tribes: Mechanisms Under Tribal and Federal Law. This article summarizes several types of emergency declarations, including tribal declarations, Stafford Act declarations, and federal public health emergency declarations, and their implications for tribes. Sunshine G, Hoss A. Emergency declarations and tribes: mechanisms under tribal and federal law. Michigan State International Law Review 2015;24:33–44.

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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 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 (HAIs), 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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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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Journal Article on relationship between prescription drugs and heroin use. The New England Journal of Medicine published “Relationship between Nonmedical Prescription-Opioid Use and Heroin Use,” Longo, Dan L., Wilson M. Compton, Christopher M. Jones, and Grant T. Baldwin. New England Journal of Medicine N Engl J Med, 2016, 154-63. The review offers policy insights and context surrounding the problems of nonmedical prescription opioid and heroin use.

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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 and a preliminary agenda are available now.

Concentrated Animal Feeding Operations Laws Related to Odors. The United States has seen a significant increase in large-scale animal farming. Large-scale animal farms are classified as either animal feeding operations or concentrated animal feeding operations (CAFOs), depending on the number of animals housed. PHLP has released a Menu of State Concentrated Animal Feeding Operations Laws Related to Odors [PDF - 400KB], which examines state laws on CAFOs and the environmental odors they produce, and a Research Anthology for CAFOs and Public Nuisance Law [PDF 200KB].

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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.

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Youth Sports Traumatic Brain Injury Laws Map. Public Health Law Research published Youth Sports Traumatic Brain Injury Laws Map on LawAtlas. The dataset and map identify and display key features of laws aimed at reducing harm from brain injuries occurring at scholastic youth sports activities.

Vermont: Lawmakers: Opiates ‘have to be’ the focus of 2016 session
Burlington Free Press   (01/05/2016)   Elizabeth Murray

Prescription opioid regulation, education, continued drug addiction treatment, and education and care coordination are among the elements Vermont legislators could focus on in the 2016 session, according to Barbara Cimaglio, Vermont Department of Health’s deputy commissioner for alcohol and drug abuse programs. This focus represents continued momentum on opioid-related legal interventions that has been growing since Vermont Governor Peter Shumlin’s 2014 State of the State address, which was devoted to tackling the state’s prescription drug injury and abuse problems.

Vermont’s health commissioner, Harry Chen, believes the state’s regulatory focus should be on opioids prescribed for non-cancer related, acute, and chronic pain, as well as a statewide drug disposal program, and provider education. “To the extent that we can work on that edge of the spectrum, we can have benefits in terms of reducing the number of Vermonters who are addicted to opioids and turned to heroin for sometimes economic reasons,” said Chen.

Vermont has already made several steps to remedy the situation. Several rules aimed at tightening prescription opioid monitoring and regulations have recently taken effect. These rules require all controlled substance prescribers register with the Vermont Prescription Monitoring System and check the system before writing a new prescription. The prescribing physician must also conduct and record a risk assessment, consider non-opioid and non-pharmacological treatments, and follow up with patients to verify prescribed treatment is working. Another rule, scheduled to take effect in March 2016, seeks to prevent buprenorphine from entering the drug market by requiring physicians to monitor patient’s medication-related behaviors.

[Editor’s note: Learn more about Vermont’s Prescription Monitoring System Rule [PDF - 407KB], Rule Governing the Prescribing of Opioids for Chronic Pain [PDF - 215KB], and Rules Governing Medication-Assisted Therapy for Opioid Dependence [PDF - 384KB].]

California: Porter Ranch gas leak triggers state of emergency in California
CNN   (01/07/2016)   Ben Brumfield and Lorenza Brascia
[Editor’s note: Learn more about California Governor Edmund G. Brown, Jr.’s emergency order for the Aliso Canyon Gas Leak.]

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Florida: Florida ‘pill mill’ crackdown saves thousands of lives, study says
West Texas news   (12/22/2015) Leah Gardiner
[Editor’s note: Read Opioid Overdose Deaths and Florida’s Crackdown on Pill Mills. American Journal of Public Health. Kennedy-Hendricks A, Richey M, McGinty EE, Stuart EA, Barry CL, Webster DW. 2015 (e-View Ahead of Print).]

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Nebraska: Three Rivers selected by CDC to jump-start pilot program
Fremont Tribune   (01/09/2016)   Sam Pimper
[Editor’s note: Learn more about Flu on Call.]

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New York: New York City’s flu shot mandate for young children is struck down
New York Times   (12/17/2015)   Marc Santora
[Editor’s note: Garcia v. New York Dep’t of Health and Mental Hygiene, 161484/2015 (NY Sup. Ct. Dec. 16, 2015).]

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Washington: As legal marijuana expands, states struggle with drugged driving
KTOO Public Media   (01/09/2016)   Sarah Breitenbach
[Editor’s note: Read about state marijuana impaired driving laws.]

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West Virginia: The lawyer who became DuPont’s worst nightmare
New York Times   (01/06/2016)   Nathaniel Rich
[Editor’s note: Learn more about the Toxic Substances Control Act.]

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National: A young football star ‘in the prime of life,’ and the disease that destroyed his brain
The Washington Post   (01/05/2016)   Sarah Kaplan
[Editor’s note: Learn more about youth sports traumatic brain injury laws on LawAtlas and about CDC’s HEADS UP Concussion in Youth Sports initiative.]

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National: FDA overturns 30-year ban on blood donations by gay men
Reuters   (12/22/2015)   Toni Clarke
[Editor’s note: Read more about the US Food and Drug Administration’s revised recommendations for reducing the risk of HIV transmission by blood and blood products.]

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National: FDA adds transvaginal mesh implants to Class III risk procedures
Regal Tribune   (01/05/2016)   Lori Martinez
[Editor’s note: Read more about FDA’s requirements regarding transvaginal mesh implants.]

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National: Funding ban on needle exchanges is effectively lifted
USA Today   (01/07/2016)   Laura Ungar
[Editor’s note: Read Title V, Section 520 of the Consolidated Appropriates Act, 2016 [PDF - 2.93MB] for more information about federal funding for needle exchanges.]

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National: Is Obama’s executive action on guns legal? Let’s break it down
The Washington Post   (01/05/2016)   Philip Bump
[Editor’s note: Learn more about President Obama’s recent plan to reduce gun violence released on January 1, 2016.]

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National: Kratom, an addict’s alternative, is found to be addictive itself
New York Times   (01/02/2016)   Alan Schwarz
[Editor’s note: Learn more about the FDA’s seizure of supplements containing kratom.]

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National: VW faces billions in fines as US sues for environmental violations
Reuters   (01/06/2016)   Julia Edwards and Georgina Prodhan
[Read the United States Department of Justice’s complaint against Volkswagen, Audi, and Porsche for alleged Clean Air Act violations.]

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International: First dengue fever vaccine gets green light in 3 countries
Scientific American   (12/30/2015)   Dina Fine Maron
[Editor’s note: Learn more about dengue fever.]

Interview with Matthew S. Penn, Director, CDC’s Public Health Law Program

Title: Director of CDC’s Public Health Law Program

Education: BA, English from the University of Georgia, MLIS and JD from the University of South Carolina

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Public Health Law News (PHLN): Can you please describe your career path?

Penn: Following graduation from the University of South Carolina’s School of Law, I had the opportunity to work as a staff attorney with the South Carolina Supreme Court. This position allowed me to study how the law directly interacts with people's lives and how cases work their way through the court system.
After my time at the court, I accepted a position as a staff attorney with the Department of Health and Environmental Control (DHEC), South Carolina's public health and environmental protection agency. In my first few years, I split my time between environmental litigation and traditional public health clients. Eventually, I shifted to the preparedness and public health side of the agency. My public health clients within DHEC were primarily the Bureau of Environmental Health and the Bureau of Disease Control. Working with the public health professionals in these programs showed me how many different professional disciplines have to collaborate for public health practice to have an impact on communities. The experience demonstrated the impact we can have when science and law work toward a common goal.
In April 2011, I became PHLP’s director. The last five years have been a blur of activity and innovations in the public health law field.

PHLN: Looking back at the past five years, what have been the most exciting innovations in that field?

Penn: We’ve really seen a renaissance in the field of public health law; the fields of law and health are converging in a more robust and effective way, creating a completely new field, what we’re starting to call “Public Health 2.0.” The elements of this new field have been on the fringes of the traditional law and health relationship for a long time, but it’s finally coming to fruition through new, multi-faceted partnerships and through new public health law research disciplines, specifically legal epidemiology.

PHLP and its partners—ChangeLab Solutions, Robert Wood Johnson’s Public Health Law Research Program (PHLR), the Network for Public Health Law, the Public Health Law Center, the Association of State and Territorial Health Officials, and the National Association of County and City Health Officials—have played a significant role in building the field of public health law by creating and supporting a network of public health law professionals. PHLP works hard to foster these relationships and to enable state, tribal, local, and territorial (STLT) communities to use law as a tool to improve public health.

PHLN: Why is the field of public health law important to public health?

Penn: It bridges the gap between law and public health by researching, tracking, and explaining the effect of law on public health outcomes. Law directly and indirectly affects public health. All of the ten great public health achievements of the 20th century, from motor-vehicle safety to tobacco as a health hazard, were directly related to law. In each of these cases, laws were passed to improve public health, and they worked. In other situations, the positive or negative effects of the law on public health are more difficult to identify and understand. As we have more and better information about the causes of injury and disease, we need to understand the relationship between law and public health to ensure the best possible outcomes.

PHLN: Does one need to be an attorney to practice or work in public health law?

Penn: I’ve realized that the complete practice of public health law has always consisted of more than just licensed, advising attorneys. For many years, the public health law community has focused largely on things like statutes, regulations, court opinions, and memorandums of understanding and on the practice of attorneys. But, as attorneys, we’ve always been surrounded by professionals that enable and support much of our work, including academics, researchers, scientists, and public health practitioners. Non-lawyers execute much of the work that comprises public health law, and we have become increasingly aware of the transdisciplinary nature of the field. With this awareness, we’ve proposed a reframing of public health law practice in A Transdisciplinary Approach to Public Health Law: The Emerging Practice of Legal Epidemiology, in the Annual Review of Public Health, by Scott Burris, Marice Ashe, Donna Levin, Matthew Penn, and Michelle Larkin (Volume 37, publication date April 2016) Temple University Legal Studies Research Paper No. 2016-01.

PHLN: What is legal epidemiology?

Penn: Legal epi, as it is called, is the scientific study of law as a factor in the cause, distribution, and prevention of disease and injury. If a law can change the environment or behaviors around a certain health condition, legal epi can measure its effects on public health. It makes legal provisions quantifiable and standardizes research methodologies. Legal epi is a PHLP priority, and PHLP and its partners, such as PHLR, continues to support the development and validation of the field through funding and consultation.

PHLN: Legal epidemiology is a relatively new term, and its practice is still being defined. How do you anticipate the practice will grow or evolve in the coming years?

Penn: Legal epi will continue to grow because it meets a significant need. When we look at policy development as a marketplace, we see increasing demand for legal epi-related products that tell us if policies and laws are working, and if so, what impact they are having on the public’s health. Policy development and passage of laws both take resources, and legal epi will provide better data that can help us use those resources more wisely by focusing on promising interventions.

PHLN: How would you like to see legal epi used in STLT health departments and communities?

Penn: I think legal epi should have a significant effect on the way health departments interact and use the law. First, a fully developed and expressed legal epi system will provide real-time access to law and policy strategies that health departments can use to craft jurisdiction-specific interventions to address their public health priorities. Second, legal epi-oriented policy surveillance systems can help health departments collect, organize, and display their jurisdictions’ public health laws. 

PHLR recently partnered with the State of Nebraska on the Nebraska Public Health Law Project to advance knowledge and practical understanding of Nebraska’s laws governing public health practice. Through the partnership, PHLR and Nebraska have systematically collected and coded Nebraska’s laws governing public health practice and evaluated the knowledge and awareness among the state’s public health workforce. We hope the project will result in more accessible and more easily understood public health laws, which will increase the capacity and ability of the public health workforce. Of course, central to an effective legal epi system is a workforce that understands how to use law as a public health tool and has the capability to use law in the day-to-day practice. 

PHLN: How does PHLP build such a capable workforce?

Penn: We offer internships, externships, and training. Most of our workforce development is done through training, both in person and via webinar. We work with the partners listed above, as well as the American Bar Association, American Health Lawyers Association, and American Public Health Association to reach STLTs. Webinars cover many topics, and experts in specific public health fields present.

We started the internship and externship programs in 2012 and have hosted more than 25 interns since then. We try to make the intern and externship experiences engaging and varied; interns are unpaid, but the externs receive course credit. Because the internships are unpaid, the people who apply for our program are highly motivated. While we’ve taken undergraduate students and graduate students studying something other than law, because of the heavy focus on legal research, currently we really focus on providing internships to rising and current third year law students.

PHLN: What have been PHLP’s greatest accomplishments in the past five years? The greatest challenges?

Penn: I think the best thing we’ve done is help rebuild a creative and exciting environment around the practice of public health law. The community is stronger and more focused than it was five years ago, and that momentum is not only making the field an attractive career choice for new young attorneys and other practitioners, but it’s also moving us in new and exciting directions. The benefits of a robust public health law community were realized when Ebola come to the United States in fall 2014. The public health law community coalesced around the issue, working together and sharing strategies and resources to help support the domestic response. 

The renewed community has also lead to CDC making unprecedented investments in public health law through its cooperative agreement with Change Labs Solutions (CLS) in Oakland, California. CLS has channeled these investments into creating a sustainable public health law model in the Public Health Law Academy and the Legal Epidemiology Center.

PHLN:  What do you hope PHLP will accomplish in the next five years?

Penn: This year we’re celebrating PHLP’s 15th anniversary, so first we’ll continue to build on the successes we’ve realized during the past 15 years, but specifically the successes we’ve accomplished through our cooperative agreement. From the creation of public health law and public health emergency law competencies to validation of legal epi methodologies, we’ll use the next five years to continue to build a solid and sustainable platform on which public health law can evolve over the next 20 years. Second, PHLP will continue to advance the use of law as a public health tool through expanded workforce development opportunities and legal epi studies. We will also continue to integrate public health law into CDC research and practice and push for a sustainable policy surveillance system and legal epi research funding.

PHLN: What has been the most rewarding part of your career thus far?

Penn: The best part of my career has been getting to work with so many smart, energetic, and creative people.

PHLN: What advice would you give people interested in studying or practicing public health law?

Penn: Read everything you can get your hands on—public health law books, journals, reports, toolkits, etc. Exposure and absorption are the best ways to learn what you’re interested in and to generate new ideas for advancing the field. Number two is practice creating and articulating new ideas and having them be shaped and modified by other ideas and people. Invent ideas, write them down, talk to other people about them, trace the ideas through research, and talk about them again. And finally, begin to think holistically about success and failure. Success is always built on a foundation of “failure,” and the typical view of these as opposites in a systemic duality is corrosive to personal and professional development. Articulating, discussing, debating, producing, modifying, stumbling, and sometimes starting over are all part of moving forward, and moving forward is what “success” is all about.

PHLN: Have you read any good books lately?

Penn: I have enjoyed quite a few book recently including “Finch,” “The Ocean at the End of the Lane,” “Station Eleven,” and “The Martian.”

PHLN: If you could travel anywhere in the world, where would you go and what would you do?

Penn: First, I would go to Thailand and eat. Next I would go to Argentina and walk. Then I would go to Germany and England and drink beer. Then I would come home and rest!

The first reader to correctly answer the quiz question will be given a mini public health law profile in the February 2016 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: January 2016

What is the closing date for the Public Health Law Program’s summer 2016 internship and externship applications?

Annette E. Groves

December Question: What sport is one of Joe Finn’s hobbies?

Winning response: 
Lacrosse

Employment organization and job title: I am a registered nurse at the Lake Region District Health Unit (LRDHU) in Devils Lake, North Dakota. I am the director of nursing and Ramsey County’s public health nurse. 

Brief job description: I created and implemented a mandatory influenza vaccination policy within our health district and work closely with the North Dakota Department of Health on immunization practice and policy. My nursing duties include a wide array of activities, including

• Disease surveillance and prevention
• Immunizations—pediatric and adult populations
• Mass vaccination clinics
• Child passenger safety
• Maternal child health
• Tobacco use/exposure/cessation (Ask, Advise, Refer in client-based programs)
• School screening programs
• Coalition member for Child Protection Services
• Health screenings (tuberculosis, hypertension, cholesterol, etc.)
• Community health fairs
• Educator

Education: I have a bachelor of science in nursing, have four years of hospital and clinical experience, and nearly eighteen years of public health nursing experience.

Favorite section of the News: I enjoy the learning opportunities gained from the Public Health Law Newsletter. The interviews with various legal experts tends to be the first section I read, but all the sections of the News are my favorites. 

Why are you interested in public health law? LRDHU does not have the expertise of legal counsel within our local agency, so the News is a great resource for our staff and administration.

What is your favorite hobby? I enjoy reading, running, and playing with my grandchildren.

Louisiana: Plaintiff failed to show that defendant caused or created the hole on public property that caused plaintiff’s injuries
Cusimano v. Caillouet
Court of Appeals of Louisiana, Fifth Circuit
Case No. 15-CA-374
Filed 12/23/2015
Opinion by Judge Fredericka Homberg Wicker

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Federal: Attorney’s fiduciary duty to client would ensure client reimbursed for overcharges for copies of health records
Ruzhinskaya v. HealthPort Technologies, LLC
United States District Court, Southern District of New York
Case No. 14 Civ. 2921 (PAE)
Filed 12/17/2015
Opinion by District Judge Paul A. Engelmayer

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Federal: Motion to dismiss granted, Transitional Reinsurance Program constitutional and intended to apply to private as well as government group health plans
State of Ohio v. United States
United States District Court for the Southern Division of Ohio, Eastern Division
Case No. 2:15-cv-321
Filed 01/05/2016
Opinion by District Judge Algenon L. Marbley

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Federal: Defendants-plurality shareholders owe a fiduciary duty to company to comply with Medicare reimbursement fingerprinting law
Fruth, Inc. v. Pullin
United States District Court for the Southern District of West Virginia, Huntington Division
Case No. 3:15-16266
Opinion by Chief District Judge Robert C. Chambers

Quotation of the Month: Vermont Health Commissioner Harry Chen

“Vermont’s most dangerous leftovers are what’s in the cabinet after you’re recovered,” said Vermont Health Commissioner Harry Chen of Vermont’s prescription opioid problems.