March 2017—Public Health Law News

Public Health Law: Understanding It and Using It to Your Advantage. In the Denver area? Come learn about public health law. At the 68th annual meeting of the Society of Public Health Educators (SOPHE), CDC’s Public Health Law Program (PHLP) will present a pre-conference workshop on March 29, 2017, at the Hyatt Regency in Denver, Colorado. The workshop will introduce public health law principles and key sources of law, highlighting the relationship between US law and public health practice. Individuals may register exclusively for pre-conference workshops at a reduced rate of $55. Register before March 20, 2017, to reserve your seat.

---

National Public Health Week Is April 3‒9, 2017. The American Public Health Association (APHA) is proud to announce this year’s National Public Health Week! APHA organizes the annual event to recognize the contributions and important work within the field of public health as well as highlight some of the challenges in public health. Visit the National Public Health Week website to learn more about the event and how you can get involved.

---

2017 Policy Surveillance Summer Institute Registration Open. The Summer Institute, hosted by the Policy Surveillance Program at Temple University’s Center for Public Health Law Research, will teach introductory and advanced policy surveillance and legal mapping techniques during a two-day intensive training in Philadelphia, June 8‒9, 2017. Attendees must register by May 1, 2017.

---

Journal Article Addressing Food Insecurity and Its Health Implications in Rural Tribal Communities. The article “Food Insecurity and Chronic Diseases Among American Indians in Rural Oklahoma: The THRIVE Study” examines food insecurity and cardiovascular disease–related health outcomes among Native Americans in rural Oklahoma. The article emphasizes the importance of collaborative work between tribal, federal, and state policymakers along with businesses and nonprofits to address the barriers to healthy foods and the underlying causes of food insecurity. (American Journal of Public Health 2017;107(3):441‒6. doi: 10.2105/AJPH.2016.303605).

---

The Week in Health Law
Want to learn more about current events in health law and policy? Listen to an audio podcast by Frank Pasquale, Nicolas Terry, and their guests as they discuss health law and policy issues of the week. Show notes are at TWIHL.com and the podcast is available for free on iTunes. In episode 82, University of Missouri-Columbia law professor Sam Halabi discusses corporate governance and regulation at both national and international levels. Or check out episode 63, which features a discussion on legal epidemiology and related topics with the director of the CDC’s Public Health Law Program, Matthew Penn.

Homelessness as a Public Health Law Issue: Selected Resources. This is a list of resources collected and published by PHLP that describe and comment on homelessness as a public health concern. 

---

Tribal Emergency Preparedness Law. This issue brief, published by PHLP, provides an introduction to tribal emergency preparedness law. It outlines tribal emergency preparedness authorities and offers examples of these authorities across various tribal laws. It discusses federal Indian law in the context of emergency preparedness and concludes with a discussion of cross-jurisdictional coordination between tribes and other jurisdictions.

---

City Rights in an Era of Preemption: A State-by-State Analysis. This report, published by the National League of Cities, examines the limit of state influence on city powers through preemption and how state law is used to nullify both municipal ordinances and policy areas.

---

Initial Opioid Prescription Limits. In an evaluation of states adopting initial opioid prescription limits, 16 states have either enacted a law, adopted a rule, or passed legislative bills. By looking at this information, the Association of State and Territorial Health Officials (ASTHO) identified states with existing or proposed initial prescription limits, the type of limit, and the common conditions and patients exempted from these developed limits.

---

500 Cities Data: Local Data for Better Health. This dataset includes information from the 2013—2014 model-based small areas’ estimates for 27 measures of chronic diseases related to unhealthy behaviors, health outcomes, and the use of preventive services.

---

Scope of Practice Policy. Designed by the National Conference of State Legislatures and ASTHO, this website aims to educate legislators and clinical practitioners on policy data and practice laws across the country.

National: Confronting the Challenges of Getting Timely Opioid Abuse Data
Route Fifty   (02/27/2017)   Quinn Libson

In an effort to address the opioid abuse epidemic, members of the US government, law enforcement, and medical community met in late February for the National Association of Counties town hall meeting. In the last decade, states have implemented different types of laws aimed at addressing the ongoing prescription-drug epidemic. At the town hall meeting, panel members discussed these laws and their varying degrees of success. While all of the laws were aimed at improving public health outcomes, some of these laws had devastating and unexpected consequences. For example, Florida’s H.B. 7095 law, passed in 2010, penalized over-prescribing physicians and reduced the number of pill mills in the state. Three years later, it was clear the law had achieved the intended results in Florida, but as prescription opioids became harder to obtain and more expensive, addicted drug users switched to a  cheaper opioid: heroin.

While heroin use appears to be on the rise across the country, understanding the full scope and breadth of the problem, even on a local level, is a formidable challenge. Currently, there is a disconnect in reporting standards, and when individuals are resuscitated and refuse to be transported to the hospital, there is no mandate to report. Information about overdose is spread between emergency medical technicians, emergency rooms, and fire departments with no central database used to determine where and who is being affected.

Huntington, West Virginia, made nationwide headlines after an incident in August 2016 where 26 people overdosed over the span of about four hours, but outside of these shocking stories, overdoses mostly go unrecorded. Scott Lemley is the criminal intelligence analyst for the Huntington Police Department who collects and analyzes the data surrounding and created by illicit opioid use in Huntington. Lemley describes his information system and its gaps: “We get quarterly, sometimes monthly economic data, but when it comes to drug overdoses we have to wait two years . . . it’s absolutely insane.”

In Huntington, Lemley is fortunate to have cooperation and coordination across public safety stakeholders and is provided with numbers of overdose, drug-related crime and injury information. These metrics are then used to determine overdose patterns and, alternatively, to develop staffing plans for law enforcement, locate specific locations for health promotion programs, and to develop targeted interventions that mitigate crimes and health outcomes related to opioid use.

With the work that Lemley has begun, overdose databases are now on the radars of cities across the country. His work has the potential to shift the system toward proactivity, so cities can anticipate issues of opioid use instead of reacting to the devastating aftermath.

Arkansas: Evidence from the private option: the Arkansas experience
The Commonwealth Fund (02/23/2017) Bethany Maylone and Benjamin D. Sommers

---

California: Single-payer health care bill introduced in California senate
Kaiser Health News (02/22/2017) Anna Gorman

---

Florida: Florida doctors may discuss guns with patients, court rules
The New York Times (02/16/2017) Lizette Alvarez

---

Illinois: Teen suicide attempts fell as same-sex marriage became legal
Boston Globe (02/20/2017) Lindsey Tanner
[Editor’s note: Read Obergefell et al. v. Hodges [PDF - 428KB], June 26, 2015, in which the US Supreme Court held that under the Fourteenth Amendment of the US Constitution, states must license a marriage between two people of the same sex and must recognize a marriage between two people of the same sex when their marriage was lawfully licensed and performed in another state.]

---

Indiana: Indiana's medicaid expansion plan under scrutiny
Modern Healthcare (02/28/2017) Virgil Dickson
[Editor’s note: Learn more about Healthy Indiana Plan 2.0.]

---

Kansas: Kansas House advances medicaid expansion
The Wichita Eagle (02/22/2017) Daniel Salazar

---

Maryland: Hopkins researchers suggest Baltimore offer addicts safe places to do drugs
The Washington Post (02/28/2017) Andrea K. McDaniels

---

New York: When retirement comes with a daily dose of cannabis
The New York Times (02/19/2017) Winnie Hu
[Editor’s note: Learn more about marijuana regulation.]

---

Texas: Texas challenges gay marriage benefits
BBC   (03/01/17)

---

Texas: Parents of severely disabled kids urge lawmakers to reconsider Managed-Care Plan
Dallas News (03/01/2017) James Barragan

---

National: Hospitals, both rural and urban, dread losing ground with health law repeal.
Kaiser Health News (02/28/2017) Sarah Varney

---

National: House votes to revoke OSHA recordkeeping rule, heads to senate
Bloomberg BNA (03/02/2017) Bruce Rolfsen
[Editor’s note: Read the new Occupational Safety and Health Administration’s new records rule, 29 CFR 1904.0 [PDF - 300KB]]

---

National: Attorney General Sessions wants to know the science on marijuana and opioids. Here it is.
The Washington Post (02/28/2017) Christopher Ingraham

Chile: Chile floods- drinking water returns to capital Santiago
BBC News (02/28/2017)

---

Haiti: Secretary-General asks member states to express intention on financing US plan to tackle cholera in Haiti
UN News Centre (02/24/2017)

---

Libya: Libya exposed as an epicentre for migrant child abuse
BBC News (02/28/2017) Paul Adams

---

Nairobi: African policymakers renew call for investments in TB control
Xinhua (02/28/2017) Christine Lagat
[Editor’s note: Learn about tuberculosis (TB).]

---

Syria: Syria conflict: All parties committed war crimes in Aleppo - UN
BBC News (03/01/2017)

---

Zimbabwe: Zimbabwe nurses join doctors in a strike over pay and bonuses
BBC News (03/01/2017)  

---

Global: World Health Organization releases list of antibiotic-resistant 'priority pathogens.'
Washington Post (02/27/2017)
[Editor’s note: Learn more about the list of priority pathogens.]

---

India: Tamil Nadu- traders ban Pepsi, Coca-Cola to support local products
BBC News (03/01/2017)

Interview with Gene Matthews

Title:
Director of the Southeastern Regional Center of the Network for Public Health Law; Senior Fellow at the North Carolina Institute for Public Health at the University of North Carolina Gillings School of Global Public Health

Education:
JD, University of North Carolina at Chapel Hill School of Law; BA, history and mathematics, University of North Carolina at Chapel Hill

---

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

Matthews: I graduated from law school at the University of North Carolina (UNC), and at the time, my wife was going to graduate school to get her master’s degree in public health. So, I had that ticking away in the back of my mind. After law school, I did some other things but came back to public health and was working with the Office of the General Counsel for Health and Human Services in Washington, DC, when the job with CDC opened. I took the job as chief general counsel for CDC in 1979, and it was the professional opportunity of my life. I never looked back, and I have no regrets. When I started at CDC, it was me and one administrative assistant. When I left in 2004, 25 years later, we had about 30 people working in the Office of the General Counsel for CDC, and the Public Health Law Program (PHLP) was well underway.

PHLN: How did you become interested in public health law?

Matthews: When I was at UNC, in my last year of law school I took a health law course at the UNC School of Government. That’s where I became “infected”; that was the original germ that contaminated my career. Also, my wife was a public health nurse and taught at nursing schools and was in the field. I was very interested and had been hoping to crack into the public health law field when the job came open at CDC. So, I applied and the rest is history.

PHLN: You were CDC’s chief legal counsel from 1979 to 2004. Can you describe some of the most significant public health changes and challenges you observed during your tenure?

Matthews: I feel like the Forrest Gump of public health law. I was there for most of it by great fortune. My career began with the AIDS epidemic. I was in the room in June 1981 when the first four AIDS cases were reported to the CDC director at his Wednesday afternoon staff meeting. Then, toward the end of my tenure at CDC, I was in my office on September 11, 2001, planning the first Public Health Law Conference, when my son called me from New York and told me to turn on the TV because planes had hit the World Trade Center.

So, those were the two big events that bookended my CDC career—the AIDS epidemic and all that was associated with it for about 15 years—and the emergency preparedness and public health law issues associated with first the terrorist attacks of September 11, 2001 and the subsequent anthrax attacks through the US mail, which precipitated PHLP’s creation.

AIDS was the defining issue for the career of a whole cohort of CDC leaders in the 1980s, many of whom were around from 1998–2001 and helped us develop and launch PHLP.

Within and around those two big public health events and catalysts, I worked on a variety of other issues and, with the generosity of CDC offering resources and full-time staff, I also worked to build the Department of Health and Human Services Office of the General Counsel at CDC.

PHLN: What is the Network for Public Health Law (“the Network”) and how does it advance public health?

Matthews: The Robert Wood Johnson Foundation (RWJF) created the Network seven years ago. It comprises a national coordinating center and five regional offices. I direct the southeastern regional office, which is based at UNC Chapel Hill.

The Network’s job is to build the field of public health law through three main functions: 1) provide technical assistance to practitioners in the field, be they state or local health departments or non-profits; 2) offer training, communication, and education about public health law (we offer many webinars, conference trainings, and professional development opportunities); and 3) build and serve as a connector in the field by offering opportunities to engage and network with the many public health law “nodes” and also by hosting the Public Health Law Conference.

PHLN: What are your day-to-day responsibilities as the director of the Network’s southeastern regional center?

Matthews: I supervise a staff of four attorneys and some law interns. Our first job is to address technical assistance requests from states in our region. We maintain expertise in specific topic areas that are unique to us, and we provide support to other regions as well.

Our inventory of expertise includes public health issues around prescription drug and opioids, for example. The attorney in charge of that, Corey Davis, has collaborated with CDC and the former director of the White House Office of National Drug Control Policy, Michael Botticelli, to create a robust library of information and materials about opioid-related public health law.

We also have lawyers working with the National Health Law Program who are on the cutting edge of the health law reform. Most recently they’ve been working on the proposed changes to the Patient Protection and Affordable Care Act.

PHLN: What projects have you been working on recently?

Matthews: I’ve been working with other colleagues to craft richer messages for public health to reach broader audiences. This is at the center of the advocacy piece in the Five Essential Public Health Law Services.

I’ve also spent a good deal of time building relationships between local public health departments and their area hospitals for community health needs assessments and stakeholder-building with community coalitions. We are now looking at how GIS mapping of social determinants of health at the census track area is a powerful tool for local coalition building of hospitals and health departments within local health communities. In my opinion, community coalition building is the heart of public health.

Every day is different, and every day is fresh. I think it’s neat to see how you can connect the dots. It’s a creative and exciting area of work.

PHLN: You’ve been a national leader in public health law for most of your career. During your time in the field, how has public health law changed?

Matthews: Public health law has changed significantly. I spoke about this at the opening plenary at the most recent Public Health Law Conference in September 2016. I’ve lived through much of the four areas of the modern public health law renaissance, which is an ongoing journey that we’re on.

In the first phase, from 1950 to about 2000 or 2001, legal expertise existed in isolated nodes within academia, state and large city health departments, and in non-profits. We weren’t a field, and we were all operating independently without a shared consciousness that we were working in the same area. Then, in phase two, CDC leaders in the late 1990s started looking into whether we should be doing something to build the field of public health law.

We began asking how we could build it into another recognized tool to help public health practice. The leaders for this were both inside and outside of CDC—people like Larry Gostin at Georgetown University College of Law, CDC’s Office of the General Counsel, along with Rick Goodman and Tony Moulton, who also worked at CDC. We received a lot of support from CDC leaders, including CDC Director Jeff Koplan, CDC Deputy Director Martha Katz, the director of the CDC Public Health Practice Office, Dr. Ed Baker, and, then head of CDC’s Chronic Disease Center, Jim Marks.

PHLP was launched in about 2000 or 2001, very nearly coinciding with time of the September 11, 2001, terrorist attacks on the World Trade Center and the anthrax attacks. Suddenly everyone was interested in public health law, specifically issues like quarantine and isolation. The preparedness funding streams went out to states, and we used that money to help build this field. At the same time, academic centers and non-governmental organizations began to expand, publishing and sharing their public health law research. Building on this momentum and the need for a public health law network, CDC hosted the first Public Health Law Conference in 2002, and it was like the reunion of the lost tribe. It was great.

In the third phase of the renaissance, philanthropic organizations, specifically RWJF, began funding a whole new suite of public health law initiatives around 2007. This was in great part because Jim Marks had left CDC and was a vice president at RWJF. He knew about public health law from his time at CDC and was a firm supporter. He instigated a whole cluster of new public health law initiatives, including funding a public health law research program at Temple University, supporting and working on getting a legal “Domain 6” included in the Public Health Accreditation Program, and standing up the Network for Public Health Law in 2010. So, in this era of the renaissance CDC and private foundations were really collaborating.

In this current fourth phase, we’re moving into a new territory. We’re looking at new research tools like legal epidemiology, LawAtlas, and a systems approach to public health law. We’re also looking at a transdisciplinary, multi-sector advocacy approach to the Five Essential Health Law Services, etc. A lot of these changes are based on technology. As lawyers, we all work differently from what we used to—and we collaborate more easily. Searching law effortlessly from your desk is something that wasn’t available 25 years ago. Making partnerships virtually wasn’t how you connected people back then.

PHLN: In what direction(s) do you see public health law evolving?

Matthews: Public health law evolves as public health evolves. We’re moving into new areas. The field of public health and the public health system understand that public health law is an essential part of public health practice; lawyers used to be considered as technicians, like human resources or information technology professionals—we weren’t part of the leadership thinking. But we’re at the table now, and it’s clear that when you want to change law and policy to implement an intervention, you need legal skills, lawyers, advocates, communications specialists, and scientists to make it work.

In the next four years we anticipate less emphasis on the big, federal, overarching funding streams and more emphasis on funding streams to local governments emphasizing more granular, locally driven type of initiatives. With that local focus, we’ll still need to provide public health law support because most local jurisdictions can’t afford dedicated legal support for public health. So, that’s going to be a challenge.

As changes are made to large federal infrastructure systems that have been in place since the 1960s, we’re also going to have to figure out how to continue supporting public health with modified or fewer resources.

PHLN: What advice do you have for students and young professionals interested in public health law?

Matthews: You have to figure out what your passion is and what drives you. Then whatever your passion is, do that. To me it’s public health law. You won’t make the same amount of money in public health law as you might in a silk stocking private law firm, but the amount of satisfaction is immense. So it’s been a thrill to have had this ride.

PHLN: What’s your favorite part of your job?

Matthews: Now, and in my 25 years at CDC, the best part is being able to engage people on something really meaningful. If you give me the Meyers-Briggs test, I test out as an introvert. But I can stand up and do a plenary in front of 500 people because it’s something I’m passionate for, it’s something that I know and love. It’s meaningful and thrilling to talk to people and engage with people about their real problems. Working with all these public health giants from the small pox era was a thrill in 1979. I loved it. And I’m thrilled to do it now with the Network for public health law.

PHLN: What would you be doing if you weren’t working in public health law?

Matthews: If I weren’t working in public health law, I’d be spoiling my grandchildren even more; the thrill of my day is picking up my grand girls in the afternoon and spoiling them rotten.

PHLN: Have you read any good books lately?

Matthews: Hillbilly Elegy by J.D. Vance

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

Matthews: I’d go back to the Amalfi Coast or return to Micronesia to see the atolls.

PHLN: Do you have any hobbies?

Matthews: I enjoy swimming, reading, and keeping in touch with my colleagues.

[Editor’s note: For additional reading please check out Matthews G, Burris S, Ledford SL, Baker EL, Advocacy for Leaders: Crafting Richer Stories for Public Health. Journal of Public Health Management and Practice May‒June 2016;22(3):311–5 and Public Health Law Year in ReviewLooking Back and Ahead. Public Health Law Conference. October 16, 2014.]

The first reader to correctly answer the quiz question will be featured in a mini public health law profile in the April 2017 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: March 2017

At which conference in Denver, Colorado, will PHLP present a workshop on public health law on March 29, 2017?

Joan Concilio

Question: What book did Dr. Montero recently read and enjoy?

Answer: The Quartet by Joseph J. Ellis

Employment organization and job title: 
Web Specialist, Penn State College of Medicine

A brief explanation of your job:
I manage the websites for Penn State University’s medical school, which is based in Hershey, Pennsylvania. My work primarily focuses on the college’s research mission and includes everything from content management to staff education to web development. Our main website is http://med.psu.edu, with a variety of other niche sites for particular audiences.

Education: 
I earned my bachelor of science in mathematics in 2002 from York College of Pennsylvania; currently, I'm a student in the Master of Professional Studies Program in homeland security (public health preparedness concentration) through Penn State. (That's how I came to follow the News!) 

Favorite section of the News: 
I like the News quiz because it encourages me to read more closely. The other big help as I try to keep up with what's going on is the Court Opinions section. Since my background isn't in political science, this is the area I need to read up on the most to stay in good shape for my master’s.

Why are you interested in public health law? 
My goal as a public health preparedness student is to marry my experience in communication (including 15 years as a newspaper editor) with the needs of public health. One of the key parts of that experience is clear and concise communication of laws and standards to the public, to other agencies/NGOs, and so on. I'm also interested in how communication can play a role in the policy-making process; I feel that's an area that still has much work to be done.

What is your favorite hobby? 
Practicing tae kwon do (I'm a first-degree black belt) is probably my number-one pastime. After that, I enjoy creating abstract art, scrapbooking, reading, and going on adventures with my family.

Federal: Federal government has unlawfully withheld risk corridors payments from plaintiff, Patient Protection and Affordable Care Act requires annual payments to insurers, and risk corridors program not designed to be budget neutral.
Moda Health Plan v. The United States [PDF - 239KB]
United States Court of Federal Claims
Case No. 16-649C
Filed 02/09/2017
Opinion by Judge Thomas C. Wheeler

---

Federal: Florida’s Firearms Owners’ Privacy Act’s record-keeping, inquiry, anti-discrimination, and anti-harassment provisions violate the First and Fourteenth Amendments, enforcement permanently enjoined.
Wollschlaeger et al. v. Governor of the State of Florida [PDF - 394KB] et al.
United States Court of Appeals for the Eleventh Circuit
D.C. Docket No, 1:11-cv-220260MGC
Filed 02/16/2017
Majority opinions by Judges Adalberto Jordan and Stanley Marcus

“We’re a small city with limited resources, we have to be smarter about where we target enforcement efforts and where we target resources to get people help,” says Lemley of the town’s system to track and map opioid abuse-related data, crimes, injuries, and deaths.

[Editor’s note: This quote is from Confronting the Challenges of Getting Timely Opioid Abuse Data, Route Fifty, 02/27/2017, by Quinn Libson.]