August 2016—Public Health Law News

Tribal Public Health Law Externship. CDC’s Public Health Law Program (PHLP) now offers externships in Tribal public health law for rising second or third year law students. The externship consists of 9–14 weeks of professional work experience with PHLP in Atlanta, Georgia. With rolling start and completion dates during the academic year, unpaid externships must qualify for academic credit as authorized by law schools. Applications for the spring 2016 externships are due by November 1, 2016.

---

The Week in Health Law Podcast Featuring Matthew S. Penn, Director of CDC’s Public Health Law Program. Listen to Nicolas Terry, guest host Ross Silverman, and Matthew Penn discuss PHLP and how its team of public health advisors and analysts develop practical, law-centered tools and legal preparedness resources to support practitioners and policy makers at the state, tribal, local, and territorial levels to address public health priorities. Subscribe at iTunes, listen at Stitcher Radio, Tunein, or Podbean, or search for The Week in Health Law in your favorite podcast app. (If you are new to podcasts, the iTunes FAQ web page can help.)

---

Journal Article: Vaccines and Airline Travel: A Federal Role to Protect the Public Health. This article, published by the American Journal of Law and Medicine, explores two ways in which airline travel is an likely vector for the spread of infectious disease, and argues that airlines have market-based and liability-based reasons to require passengers to be vaccinated. Christopher T. Robertson, Vaccines and Airline Travel: A Federal Role to Protect the Public Health, 42 American Journal of Law and Medicine 543 (2016); Arizona Legal Studies Discussion Paper No. 16-22.

---

2016 Public Health Law Conference. The Public Health Law Conference will take place September 15–17, 2016, in Washington, DC. The conference, hosted by the Network for Public Health Law, is for public health lawyers, practitioners, officials, policy makers, 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.

Menu of State Hand Sanitation Laws for Animal Contact Exhibits. Animals at petting zoos and agricultural fairs can be carriers of pathogens, such as Escherichia coli. Disease outbreaks at animal contact exhibits can be prevented by handwashing after contact with animals and keeping food and beverage away from exhibits. This menu assesses and provides examples state animal contact exhibit hand sanitation laws.

---

Public Health Law Competency Model: Version 1.0. [PDF - 1.37MB] PHLP’s competency model provides a framework for the knowledge, skills, and abilities expected of entry-level, supervisory, and executive-level public health practitioners in public health law. The model is for attorneys, public health practitioners, legal educators, and policy makers seeking a benchmark for satisfactory or exemplary public health law understanding and performance.

Decades after ban, lead paint lingers

Stateline   (07/27/2016)   Teresa Wiltz

Lead paint remains in an estimated 38 million homes, though the US federal government banned lead-based pain in 1977. CDC estimates that 535,000 children between the ages of one and five have elevated levels in their blood, and at least 4 million US households continue to expose inhabitants to lead.

Pediatric lead exposure is linked to behavioral problems, lower intelligence quotients, and hormonal issues. The lead contamination in Flint, Michigan, has drawn additional attention to the biological impact of lead upon small children, but lead paint remains the primary source of lead poisoning.

In 2010, federal rules were finalized, requiring workers and firms engaged in renovation, repair, and painting to be certified in lead-safe practices. Additionally, states have passed laws aimed at reducing lead poisoning. Unfortunately, enforcement of state and federal laws is inconsistent because of a general perception that the threat has been eliminated. The problem is compounded because many state laws don’t conform to federal regulations, and federal lead abatement funding fell by $66 million between 2003 and 2014.

“We’ve known how to solve this problem for years. What we lack is the political will and funding from both private and public sources. Rather than let this thing drag on for another several decades, we should do the smart thing and invest, so that kids don’t have reduced IQ’s and behavioral problems,” said David Jacobs, chief scientist at the National Center for Healthy Housing.

Jacobs isn’t the only one looking for change; in July, senators from Virginia requested additional lead testing for children eligible for Medicaid, and legislation was introduced asking for updated lead standards from the Environmental Protection Agency. Other states are considering state tax rebates for property owners removing lead, while others are considering updating their lead abatement codes.

[Editor’s note: Learn more about lead.]

---

National: DEA rejects attempt to loosen federal restrictions on marijuana
NPR   (08/10/2016)   Carrie Johnson

Marijuana is classified as a Schedule I drug under the Controlled Substances Act. Schedule I is the most restrictive category and includes LSD and heroin. On August 10, 2016, the Drug Enforcement Administration (DEA) denied requests from two governors to reschedule the drug in a less restrictive category. According to DEA chief, Chuck Rosenberg cited the US Food and Drug Administration (FDA) in announcing the DEA decision, saying that marijuana has “no currently accepted medical use in treatment in the United States.” Rosenberg elaborated, saying “This decision isn’t based on danger. This decision is based on whether marijuana, as determined by the FDA, is a safe and effective medicine, and it’s not.”

In spite of the classification and the DEA’s decision, 42 states and the District of Columbia allow some form of medical marijuana use. The DEA has allowed marijuana to be used in medical research, however, and has in fact “never denied” a researcher’s application to use lawfully produced marijuana in a rigorous medical study. Rosenberg also pointed out that research about the effects of marijuana is ongoing.

Marijuana advocates, however, are disappointed in the decision. Tom Angell, chairman of Marijuana Majority, says that most Americans support marijuana legalization. “President Obama always said he would let science—and not ideology—dictate policy, but in this case his administration is upholding a failed drug war approach instead of looking at real, existing evidence that marijuana has medical value,” Angell said of the DEA’s decision.

In spite of the DEA’s decision, the law may still be changed if federal agencies, including the FDA and DEA, change their policies—or if Congress passes a law and the president signs it.

[Editor’s note: Read the DEA’s August 10, 2016, press release, DEA Announces Actions Related to Marijuana and Industrial Hemp.]

California: Planners to continue work on winery ordinance
Santa Maria Times   (08/08/2016)   April Charlton
[Editor’s note: Learn more about the wine ordinance in the County of Santa Barbara, California.]

---

Florida: Why the Zika travel warning in Florida is so narrow. And what it means for the rest of US
The Washington Post   (08/08/2016)   Lena H. Sun
[Editor’s note: Learn more about Zika and read CDC’s travel guidance for the Miami, Florida, neighborhood with active Zika spread.]

---

Maine: Greenwood ponders ‘local food’ ordinance
Lewiston-Auburn Sun Journal   (07/31/2016)   Alison Aloisio

---

Minnesota: In fight against opioid overdoses, Bemidji law enforcement now armed with Narcan Grand Forks Herald(07/25/2016)   Grace Pastoor
[Editor’s note: Learn more about Narcan (Naloxone) use and how it can be used to prevent prescription drug overdoses and injuries.]

---

North Carolina: Local ordinances give NC dangerous dog law more ‘bite’
The Star News   (08/01/2016)   Hannah DelaCourt

---

North Carolina: State epidemiologist quits, well-testing squabble between scientists, McCrory’s administration intensifies
The Charlotte Observer   (08/10/2016)   Bruce Henderson

---

National: US declares Zika an emergency in Puerto Rico
New York Times   (08/12/2016)   Sabrina Tavernise
[Editor’s note: Read the US Department of Health and Human Services’ press release declaring a public health emergency in Puerto Rico in response to Zika outbreak.

---

National: FDA ban on e-cigarette sales to minors starts today (August 8, 2016)
The Verge   (08/08/2016)   Kwame Opam
[Editor’s note: Read more about the FDA’s regulation of electronic nicotine delivery systems.]

---

National: Federal officials seek to stop social media abuse of nursing home residents 
NPR   (08/08/2016)   Charles Ornstein and Jessica Huseman
[Editor’s note: Read the Centers for Medicare and Medicaid Services’ memo, Protecting Resident Privacy and Prohibiting Mental Abuse Related to Photographs and Audio/Video Recordings by Nursing Home Staff.]

China: China issues guidelines to legalize ride-hailing apps like Uber and Didi Chuxing
Tech Crunch   (07/28/2016)   Jon Russell

---

Great Britain: Widow’s court battle over frozen embryos
BBC   (06/20/2016)   Fergust Walsh

---

Syria: US is on target to accept and resettle 10,000 Syrian refugees
NPR   (08/05/2016)   Deborah Amos
[Editor’s note: Learn more about the US State Department’s Syrian Refugee Response and CDC’s Refugee Health Guidelines.]

Title: Public Health Analyst, Carter Consulting Contractor for Public Health Law Program (PHLP)

Education: JD (Emory University School of Law), MPH (Yale School of Public Health)

---

Public Health Law News (PHLN): How long have you been practicing public health law?

Menon: About five years

PHLN: Please describe projects you are currently working on and your day-to-day job responsibilities.

Menon: I currently serve as an expert analyst and technical advisor in public health law and policy to the CDC’s Center for Global Health (CGH) for the Global Health Security Agenda (GHSA) Public Health Law Project. This project is a cross-cutting initiative that aims to capture the legal landscape related to the GHSA for Phase One and Ebola/High Risk Non Affected (HRNA) countries. The CDC team includes Adam Brush (team lead), Emily Rosenfeld, and me, and we also have a contractor project team that is compiling data on the presence or absence of laws relating to the GHSA.

My day-to-day responsibilities include conducting technical review of materials for the development of a legal framework and tool for assessing the legal landscape in these 25 GHSA Phase I and Ebola/HRNA countries. I analyze and evaluate legal assessment methodologies used by our contractor project team and lead the issues management process. Our CDC team also provides technical assistance to CDC public health programs and Phase I and Ebola/HRNA countries in support of GHSA implementation, which includes in-depth legal and policy analysis of specific issue areas requested. Additionally, I assist with the development of global health policy, health diplomacy, and legal training modules for presentation to national and international policy makers and health ministries.

PHLN: What is your favorite part of your job?

Menon: I overall really enjoy being a part of the GHSA Public Health Law Project team in this ambitious, new initiative, which is the first of its kind to adapt legal mapping methodologies widely used in the US domestic public health field to CDC’s global health work. As law can be an effective tool that can be used to assist in the achievement of GHSA targets, many countries want this kind of information to build their public health capacity and support better, more coordinated public health action. My favorite part of the job is being able to provide policy, legal, and other analyses to support country-driven efforts to build public health capacity. Providing this kind of technical assistance to countries and GHSA implementers is extremely interesting to me because it not only allows for greater specialization in a specific country’s laws and understanding of a different legal system, but also includes the cultivation of relationships with diverse country partners. It’s exciting to be able to help countries use law as a global public health tool.

PHLN: What is global health security?

Menon: Global health security can be defined as the “activities required . . . to reduce the vulnerability of people around the world to new, acute, or rapidly spreading risk to health, particularly those that threaten to cross international borders.” Global health security refers to the capacities required for countries to be prepared to respond to public health threats and thereby reduce the risk of these threats spreading beyond their borders.

PHLN: Why should health security be a national priority for any country?

Menon: The world we live in today is such an interconnected global community where it has become increasingly evident that a disease threat anywhere can mean a public health threat everywhere. The recent spread of Zika and Ebola illustrates how diseases can spread across national borders, thus posing a public health risk to all countries, which elevates global health security as not just a global priority, but an important priority for all countries at the national level. Thus, building capacity of a country’s domestic public health system to be able to respond to such public health threats will help prevent or reduce the spread of disease across localities, states, provinces, national, and international borders.

PHLN: What is the GHSA?

Menon: The Global Health Security Agenda (GHSA) was launched in February 2014 and is a growing partnership of about 50 countries, international organizations, and non-governmental stakeholders to help build countries’ capacity to prevent, detect, and rapidly respond to public health threats. The GHSA aims to help create a world safe from infectious disease threats, elevate global health security as both a national and global priority, and also helps with implementation of the International Health Regulations.

PHLN:  Who decides what issues are on the GHSA and how?

Menon: In 2014, GHSA member countries identified 11 GHSA Action Packages to guide countries as they build their capacity to prevent, detect, and respond to public health threats. Technical experts from countries around the world worked together to develop these Action Packages which have been agreed upon by all GHSA countries. These 11 Action Packages include

• Prevent 1: Antimicrobial Resistance
• Prevent 2: Zoonotic Disease
• Prevent 3: Biosafety and Biosecurity
• Prevent 4: Immunization
• Detect 1: National Laboratory System
• Detect 2 & 3: Real-Time Surveillance
• Detect 4: Reporting
• Detect 5: Workforce Development
• Respond 1: Emergency Operations Centers
• Respond 2: Linking Public Health with Law and Multisectoral Rapid Response
• Respond 3: Medical Countermeasures and Personnel Deployment Action Package

Each Action Package includes a 5-year target, indicator (s) to measure progress and lists of baseline activities to support successful GHSA implementation.

PHLN:  What is CDC’s role with the GHSA?

Menon: CDC is working directly with countries through the GHSA to help with its implementation along with other US agencies and global partners given its technical expertise and extensive experience in GHSA action package areas. While CDC is supporting the implementation of all of Action Package targets, it is focusing on four key areas: 1) national laboratory systems, 2) real-time surveillance, 3) workforce development, and 4) emergency operations centers. CDC is using its strong relationships with Ministries of Health and other partners to provide assistance as needed to help with GHSA implementation.

PHLN: Please describe your project relating to the GHSA.

Menon: The GHSA Public Health Law Project is analyzing how law plays a role in implementation of the GHSA. By compiling data on the presence or absence of laws related to each of the 11 GHSA targets, and by connecting this information to country implementation activities, the project provides a valuable resource for program implementation. Currently, the project includes mapping the legal landscape for all GHSA phase one and Ebola/HRNA countries. The legal mapping project, which has been on an accelerated timeline, is expected to be completed in September 2016. 

The project team has worked extensively to gain a deep understanding of GHSA implementation activities. Our team is also available to conduct in-depth policy analysis of specific issue areas and develop and deliver training on the use of public health law as a tool. This kind of technical assistance to countries when requested is especially helpful in countries where access to legal resources and technical support is limited.

PHLN: What do the GHSA targets have to do with law and what impact might this legal project have on public health?

Menon: Law can be an effective tool that can be used to assist in the achievement of GHSA targets, which is why many countries want this kind of information being collected by the GHSA Public Health Law Project. The legal data will be crucial for countries to understand what gaps may exist in their laws that must be overcome to help build their public health capacity. The legal data obtained from this project can also be a useful resource when countries want to update their public health laws. The legal data may provide the basis for future legal evaluation studies to determine impact of laws on improving public health outcomes.

PHLN: What has been your most rewarding experience in this project so far?

Menon: My most rewarding experience in this project so far has been our in-country technical assistance visit to Liberia. In April, the GHSA Public Health Law Project team was invited by the Liberian Ministry of Health’s (MOH) Legal Counsel and CDC’s Liberia Country Office director to work with the Liberian MOH to help document public health challenges that could be improved by updating Liberia’s public health law, which was last fully revised in 1976. The MOH Legal Counsel has been leading efforts to help modernize Liberia’s public health law which is a massive undertaking. Our visiting team to Liberia included Emily Rosenfeld and me, and we were joined by Professor Aimee Wall and Jeffrey Austin from the University of North Carolina at Chapel Hill (UNC), School of Government, who were also invited for public health law support by Liberia’s chief medical officer.

Building on our GHSA Public Health Law Project work, we assisted with gap analyses of Liberia’s existing laws to identify potential areas in need of strengthening and also provided observed practices from other countries from preliminary legal data collected. On the ground, we also participated in stakeholder engagement and in our meetings began the process of documenting how Liberia’s law facilitated and hindered with an effective response to Ebola. Through this work, we began identifying priority needs that could be addressed by the Liberia’s government in revisions to Liberia’s public health law. Now back at headquarters, our next steps include facilitating further stakeholder engagement to help move the public health law revision process forward and continuing gap analysis and legal research as requested by the MOH.

The trip allowed us to hear from stakeholders directly about priority needs in the field. We were able to get a lot of useful information and a better understanding of the Liberian legal system. As a public health lawyer who is often conducting legal and policy research in an office setting, it was inspiring to be in the field and meet public health practitioners and hear about their day-to-day experiences. It’s a reminder that our legal and policy work does affect real communities.

PHLN: How can people learn more about the GHSA and preventing future outbreaks?

Menon: GHSA’s website, CDC’s GHSA website, and CDC’s GHSA Frequently Asked Questions page are great resources for people who want to learn more. Keeping up with our GHSA Public Health Law Project will also provide information on developments relating to the laws—feel free to reach out to us!

PHLN: You have experience with a variety of cultures. What countries have you lived in and what languages do you speak?

Menon: I have lived in Singapore, Japan, India, Bahrain, and the United States. I speak Hindi, Tamil, Telugu, Kannada, Spanish, and French (un petit peu), not forgetting English! I do need to practice some of these language skills as I am getting rusty . . .

PHLN: Have your experiences in countries outside of the United States helped you in your current position? If so, how?

Menon: Absolutely! Having exposure to different cultures underscores the need to keep an open mind and recognize that there can and will be different approaches to addressing the same issue. It strengthens communication skills because you need to be able to bridge culture gaps, figuratively, and sometimes literally, to translate ways of thinking. It’s helped me recognize that one size does not fit all—different resources and ways of doing things may differ from the system you are used to. This is especially relevant when working with other countries—their legal systems, languages, and cultural and traditional priorities may be very different from ours. Recognizing and adapting to the cultural context and resource setting is important, especially when working in the global context.

PHLN: What would you be doing if you weren’t working on global health security?

Menon: Global health law and policy is of special interest to me given my international background.  In the domestic setting, I’ve enjoyed working on legal projects on prescription drug overdose prevention laws, health system transformation, and emergency antiviral distribution. Our public health law field is so diverse, and PHLP gets so many interesting projects, that I like learning about new areas. If I weren’t in public health law, international relations would be my alternate field.

PHLN: Have you read any good books lately?

Menon: No books to recommend, but I’m an avid movie watcher and would recommend Star Trek Beyond!

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

Menon: That’s a tough question as there are so many places on my wish list! If I had to pick, I’d travel to Cambodia so I could see Angkor Wat.

PHLN: Do you have any hobbies?

Menon: I am a foodie and like to try out new restaurants—that’s a hobby, right?

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

---

Public Health Law News Quiz Question: August 2016

On what podcast was PHLP Director Matthew S. Penn interviewed in July 2016?

Lia M. Anderson

Question: What program published Public Health Competency Model: Version 1.0. [PDF - 1.37MB]?

Answer: CDC’s Public Health Law Program!

Employment orgpdfanization and job title: Fort Belvoir Community Hospital, Public Health Clinical Nurse Specialist

A brief explanation of your job: Currently, I lead the Public Health Nursing's Community Health Promotions Program. My job entails performing community assessments and using results to design, develop, promote, and implement population-based programs to help people make healthier lifestyle choices. I also serve as the Seasonal Influenza Vaccination Program manager for the hospital.

Education: BA, law enforcement; BS, nursing; MS, nursing, with a focus in public health nursing administration

Favorite section of the News: “Briefly Noted” is a great way to get a quick recap of newsworthy information that may affect my practice.

Why are you interested in public health law? Having both a public health nursing and law enforcement background, I enjoy discovering how they both work together in practice. Most people think public health law only deals with the aspect of “powers of enforcement.” I try to incorporate legal findings or decisions in my community outreach to show the broader application of public health law for social justice and advocacy.

What is your favorite hobby? Right now . . . Kayaking on the Potomac!

California: Medical marijuana dispensary’s claims for loss of licensing under new zoning laws found moot
Greenhouse Herbal Center LLC v. City of Los Angeles, Cal.
Court of Appeals of California, Second District, Division Eight
Case No. B261909
Filed 07/29/2016
Opinion by Justice Tricia A. Bigelow

---

Connecticut: Sex-offender status cannot be retroactive grounds for removal from housing assistance program
Shannon v. Commissioner of Housing
Supreme Court of Connecticut
Case No: SC 19562
Filed: 08/02/2016
Opinion by Justice Richard A. Robinson

---

North Carolina: Execution of warrant for medical records in DUI case did not violate physician-patient privilege
State v. Smith
Court of Appeals of North Carolina
Case No. COA 15-1364
Filed: 08/02/2016
Opinion by Chief Appellate Judge Linda M. McGee

---

Federal: EPA acted within authority to adopt new deadlines to avoid imposing retroactive burdens on states seeking to achieve air quality standards
Wildearth Guardians v. EPA
United States Court of Appeals, District of Columbia Circuit
Case No. 14-1145
Decided: 07/29/2016
Opinion by Judge Sri Srinivasan

Quotation of the Month: Rebecca Morley of the Pew Charitable Trusts

“Very few communities have invested in getting rid of all the lead paint in housing. The main thing preventing us from eradicating this disease has to do with the perception that the problem is solved,” said Rebecca Morley of the Pew Charitable Trusts, who for years worked on lead abatement with the US Department of Housing and Urban Development.

[Editor’s note: This quote is from Decades after ban, lead paint lingers, by Teresa Wiltz, Stateline (07/27/2016).]