June 2017—Public Health Law News

Public Health Law Program | Office for State, Tribal, Local and Territorial Support |
Centers for Disease Control and Prevention

Subscribe to Public Health Law News

In This Edition

Announcements

Webinar About Healthcare Data and the Law. CDC’s Public Health Law Program (PHLP) is cosponsoring a three-part webinar series with the American Health Lawyers Association called “The Intersection of Public Health and Healthcare: Healthcare Data and the Law in the 21st Century.” The first webinar will offer an overview of current trends in laws regarding electronic health records (EHRs) and the legal and security concerns that have developed alongside EHRs. This webinar will provide a legal framework for implementing and operating EHR systems and identify cybersecurity concerns and how they can be mitigated. This free webinar will take place June 21, 2017, 1:00–2:30 pm (EDT).

Registration Now Open for NACCHO Annual 2017. The National Association of County and City Health Officials (NACCHO) Annual Conference provides a venue for local public health department staff, partners, funders, and others who are interested and invested in local public health to share their latest research. This year’s conference, “Public Health Revolution: Bridging Clinical Medicine and Population Health”, will be held in Pittsburgh July 11–13, 2017.

Journal Perspective: State Sepsis Mandates—A New Era for Regulation of Hospital Quality. This perspective from the New England Journal of Medicine evaluates sepsis regulations in New York State. The New York State Department of Health reported a decline in sepsis mortality, but the decline might not have been due to the regulations. Sepsis mortality has decreased across the nation, even in places without sepsis regulations. Potential adverse consequences of the regulations are still unknown.

Legal Tools

Tennessee Department of Health: Infectious Disease Training for Law Enforcement. This online training helps law enforcement personnel understand how to interact with people who might have highly infectious diseases. It uses Ebola as an example but can be applied to situations involving other infectious diseases. The training provides background on the Ebola virus, explains how to use personal protective equipment, and describes how to stay safe when encountering someone who might be sick.

Michigan Judicial Institute: Special Pathogens Legal Training and Tabletop Exercise .Michigan Judicial Institute: Special Pathogens Legal Training, Parts One and Two. This two-part training reviews state and local emergency management systems, emerging public health threats, and relevant laws. It focuses on the courts’ role during a special pathogen outbreak.

Briefly Noted

Arizona: CVS is the latest to ease access to opioid-overdose drug in Arizona
The Arizona Republic: Arizona Central (05/23/2017) Robert Gundran

Florida: He helped his overdosing friend by calling 911. Police slapped him with a manslaughter charge.
Vox (05/24/2017) German Lopez
[Editor’s note: Learn more about Good Samaritan overdose prevention laws.]

Florida: ‘I was panicked’: Deaf patients struggle to get interpreters in medical emergencies
STAT (05/22/2017) Leila Miller
[Editor’s note: Read Silva v. Baptist Health South Florida, Inc., No 16-10094 [PDF – 171KB], filed 05/08/2017, in the US Court of Appeals for the Eleventh Circuit, which holds that an adverse medical outcome is not required for a successful patient case if the disabled patient was not afforded the opportunity to participate in his or her medical care.”]

Iowa: Reminder: New school immunization requirement
Des Moines Register (05/16/2017) Staff Reports
[Editor’s note: Read the new Iowa Immunization Requirements.]

Maryland: Deputy, EMTs exposed to opioids get medical treatment
CNN (05/22/2017) Chris Boyette and Amanda Watts
[Editor’s note: Learn more about fentanyl.]

New York: Insider-Trading Case Ensnares Hedge Fund
New York Times (5/24/2017) Alexandra Stevenson and Matthew Goldstein

Ohio: Dewine suit blames drug manufactures for fueling opiate epidemic
Cincinnati.com (5/31/2017) Jessie Balmert
[Editor’s note: Read the complaint filed by the Ohio attorney general.]

Texas: Texas Senate approves bill aimed at identifying postpartum depression
Statesman (5/23/2017) Sean C. Walsh
[Editor’s note: Read Texas House Bill 2466 [PDF – 44KB].]

National: As telemedicine grows up, it needs some ground rules
Healthcare Dive (06/01/2017) Shannon Muchmore

National: Car accidents remain a top child killer, and belts a reliable savior
The New York Times (05/29/2017) Nicholas Bakalar

National: G.O.P. Health Bill would leave 23 million more uninsured in a decade, C.B.O. says
New York Times (05/24/2017) Robert Pear
[Editor’s note: Read the Congressional Budget Office Report on H.R. 1628, American Health Care Act of 2017.]

National: States fear price of new Zika vaccine will be more than they can pay
NPR (05/30/2017) Alison Kodjak

Cherokee Nation: Emergency management now a type 3 FEMA response team
Native News Online (05/16/2017) Staff

Global Public Health Law

Australia: Australia plans to deny passports to child sex offenders
NPR (05/30/2017) Bill Chappell

Democratic Republic of the Congo: Ebola vaccine approved for use in ongoing outbreak
Nature (05/30/2017) Amy Maxmen
[Editor’s note: Learn more about Ebola.]

Germany: Germany vaccination: fines plan as measles cases rise
BBC News (5/26/2017)
[Editor’s note: Learn more about measles.]

South Sudan: Japan and WHO to establish the first Public Health Emergency Operations Centre in Juba, South Sudan
World Health Organization (05/24/2017)

Zambia: The world’s most toxic town: the terrible legacy of Zambia’s lead mines
The Guardian (05/28/2017) Damian Carrington

Profile in Public Health Law: Jon Wollenzien, Jr.

Interview with Jon Wollenzien, Jr.

Title: Chief Executive Officer, YourTown Health, and Adjunct Professor, Rollins School of Public Health

Education: BBA, Marshall University, MHA, University of Osteopathic Medicine and Health Sciences, DBA, Nova Southeastern University

Wollenzien: My first job out of undergraduate school was with Valley Health Systems (VHS), a network of community health centers serving the uninsured and underinsured rural population in West Virginia. I accepted a nine-month administrative internship position there, and due to timing, luck, and attrition, I was moved into a site administrator position after about six months. The CEO of VHS, Steve Shattls, became my mentor. I trained under him for three years and started to get the itch to expand my career. I applied for an opportunity in Des Moines, Iowa, at a community hospital recruiting administrative staff. I was offered the position of assistant administrator. I had just turned 24 years old and started to feel pretty good about myself.

After moving my family to Des Moines, I quickly realized that I might have gotten myself into something a little over my head. The hospital was in the middle of a financial and operational turnaround. I spent most of my time trying to convince community physicians to give the hospital and staff another chance to care for their patients. I lacked the skills and training to work in a turnaround environment. I was scared to go to work each day, fearing I would make a critical mistake.

During the first six months in that job, the total administrative team (except me) left the hospital. I was promoted to associate administrator, and over the next year, one of the corporation’s turnaround experts and I successfully turned the hospital around. I was transferred to the corporation’s flagship acute care hospital in Dunwoody, Georgia. I was there for about a year and was extremely antsy to move on. The hospital was run too well, and by then I was used to working in a turnaround environment. From there, I became the vice president at South Fulton Medical Center in East Point, Georgia, and served in that role for seven years.

In my sixth year at the hospital, a community health center south of Atlanta contacted me looking for administrative support to help them redesign their internal operational and financial processes. Intrigued, I met with the board of directors, and the hospital agreed to provide contract management services. Being the only executive with community health experience, I jumped on this opportunity. The community health center completed its redesign in about one year. Then, the federal Bureau of Primary Health Care (BPHC) asked if I would be willing to assist a network of two community health centers that had run into financial trouble.

Again, I jumped on the opportunity. About six months in, the BPHC asked if I would merge the two community health center corporations to form one community board. Although no easy task, they merged in 1995, and one nine-member board was formed out of 30 community board members. I realized I really disliked hospital administration and knew my calling was right where I started―in community health. I resigned from South Fulton Medical Center in 1996 and became the full-time CEO of Palmetto Health Council, Inc., doing business as YourTown Health. It’s the only job I’ve ever had where I look forward to going to work each day.

PHLN: What specifically drew you to public health and the healthcare field in general?

Wollenzien: My mother was a highly dedicated nurse. She worked at St. Mary’s Hospital in Huntington, West Virginia, with pediatric patients. I never understood how she could work with such sick children. But she is special, and it takes someone special to work with fragile people. I remember her taking my toys to some of the children on her floor because they didn’t have anything to play with. It never bothered me because at an early age, I understood how blessed I was and how tragic some people’s lives can be. My mother left the hospital to work with the Women, Infants, Children Program (WIC) program at Valley Health Systems. When I was graduating from Marshall University with a degree in business management, I didn’t know what I wanted to do. My mom introduced me to her CEO, Steve Shattls, who hired me as an intern. I was sort of cast into health care and quickly realized there was nothing else I’d rather be doing. I’ve always cared a great deal about people and about assisting them any way I can to improve their lives.

PHLN: Can you explain the difference between hospital administration and community health?

Wollenzien: It all comes down to who your customer is. One of the reasons I became disenchanted with hospital administration is that I lost touch with the customer. As a hospital administrator, you clearly understand that your hospital relies exclusively on community physicians for inpatient admissions and outpatient testing referrals. The customer in this scenario is the admitting physician. You realize there is a patient in there somewhere, but you become removed from that interaction and spend your time meeting the needs of the medical staff. Don’t get me wrong―I’ve always loved the medical staff, and many of the physicians have remained good friends of mine. But, I’m more drawn to grassroots, community medicine. I need to see the impact my role in the healthcare industry has on communities and families. I couldn’t get this in the hospital because I was disconnected from the patients. Sometimes at South Fulton, I’d work with the transporters or down in the cafeteria serving food, just so I could interact with the patients and their families. Both administrative positions have the same financial and personnel stressors; it’s how the customer is defined that separates the two roles.

PHLN: Please describe YourTown Health and your activities as its CEO.

Wollenzien: YourTown Health is a network of seven federally qualified health centers (FQHCs) that serve Georgia’s uninsured and underinsured citizens. YourTown Health provides comprehensive primary care services, including family medicine, internal medicine, obstetrics, behavioral health, dental care, and in-house and mail-order pharmacy programs. All of our offices are recognized by the National Committee for Quality Assurance as patient-centered medical homes, with the exception of our newest office in Senoia, Georgia, which is currently going through the evaluation process. YourTown Health is a founding member of the Accountable Care Coalition of Georgia, a Georgia accountable care organization, along with 19 other Georgia FQHCs.

As CEO, I’m responsible for the corporation’s overall strategic direction. I work closely with the corporation’s community board to ensure the organization is compliant with all local, state, and federal regulations, as well as with its internal compliance program. This role is the direct liaison between the corporation and all federal agencies, such the Health Resources and Services Administration, BPHC, and Office of Pharmacy Affairs. I have purposefully designed and implemented a flat organizational structure to improve day-to-day communication and operations. I have direct oversight of the corporation’s chief medical officer, chief financial offer, dental director, director of pharmacy, and all operational managers. I spend much of my time putting out the little fires that arise daily from payers, patients, regulators, staff members, and community members.

PHLN: The goal of a community health center is to provide care to people who typically lack the access and means to do so. How do you provide that care with the limited funds you are allowed to use?

Wollenzien: Based on YourTown Health’s most recent audited US Uniform Data System report (2015), 98.3% of YourTown Health patients live at or below 200% of the poverty level. This number is above both the state and national FQHC averages of 92.6% and 92.2%, respectively. About 82% of YourTown Health patients live at or below 100% of poverty, compared with the state average of 72.7% and the national average of 70.9%. Of YourTown Health’s total patient population, 62.1 percent are uninsured, compared with the state average of 42.4% and the national average of 24.4%.

The financial implication of these statistics on YourTown Health’s operations could be devastating if we didn’t stay ahead of them with its organizational structure and processes. In 2015, YourTown Health had one of the lowest costs per patient in the nation, reporting a cost of $438.32 per patient (the national average was $826.84, and the average in Georgia was $596.43). A flat organizational structure, micromanaging of internal operations, and cross-training personnel has enabled us to hold down operational costs. Without implementing and managing aggressive cost control processes, we couldn’t operate all of our services and locations. Focusing on continual quality improvement, whether clinical or operational, has enabled YourTown Health to reduce and control the care costs.

PHLN: How do you think public health law affects the ability of organizations like yours to provide quality care?

Wollenzien: Most public health laws and regulations focus on improving clinical outcomes and protecting the patient. But, I’ve always felt that there has been a significant disconnect between the lawmakers and the providers. Many current laws and regulations place additional burden on the care provider. I’m not convinced that all of these laws and regulations actually have led to improvements in the quality of patient care and protection of the patient. Recent movements to value-based reimbursement methodologies might actually create greater barriers to care for people who are traditionally medically noncompliant. Those patients might drive down the clinical outcomes of a particular provider, significantly affecting provider reimbursement and income. Providers might be less willing to accept a noncompliant patient into their practice knowing that the patient might impact their personal finances. A patient with no medical home ends up in the emergency room seeking care that could have been provided in the community. In general, I understand the underlying thinking about many of the public health laws; however, I believe that more thought by lawmakers should be provided in reference to the downstream implications on all providers.

PHLN: You are from West Virginia and have worked in Iowa and Georgia. How have your experiences in these states shaped your understanding of access to quality care?

Wollenzien: I’ve learned that each state addresses access to care differently. Outside of Medicaid, many states do very little to facilitate access to care. When I was in West Virginia, I witnessed a state that seemed to do a lot for its people. I didn’t realize at the time that one of its senators, Robert Byrd, was exceptional at steering federal funds to the state. Regardless, those federal funds did expand services and create additional points of access to quality care. Georgia and Iowa rely on federally funded programs to address access to quality care. If the Neighborhood Clinic program hadn’t been started under Lyndon Johnson’s “War on Poverty” in the 1960s, I’m not sure the states would have responded with their own solution to accessing quality care. States have a larger role to play in creating more access to care, but in our current environment, I see more states holding back than expanding. The uncertainty surrounding future Medicaid funding will force states to retrench their efforts to expand access.

PHLN: What challenges do you face in your role as CEO?

Wollenzien: Balancing all of the ever-increasing demands placed on my medical staff against mechanisms to improve their quality of life. How do we keep our medical staff satisfied with their work and at the same time accomplish all of the demands placed on them by our payers and regulators?

Physicians in today’s healthcare environment have expectations placed on them that are next to impossible to meet. Electronic health records have completely changed the game for providers. Productivity suffers tremendously because providers are required to navigate slow and arduous systems. Across the nation we hear how the personal satisfaction and morale of medical providers has decreased due to the extra demands associated with electronic health record keeping. Value-based reimbursement methodologies will place even more stress on providers who already spend their evenings finishing the charts of patients they treated earlier in the day. Physicians are spending less time with their patients, families, and friends, and more time on electronic records.

PHLN: What challenges face community health more generally?

Wollenzien: The biggest challenge is creating new points of access to quality healthcare services with limited funds. The demand to generate clinical outcome data has forced community health centers to spend monies on IT personnel, software, and equipment that previously were used to provide patient care and expand services.

Management of health information is also a significant challenge—everyone has a system that’s generally proprietary in nature and doesn’t communicate easily with other systems. We’re supposed to be in an electronic environment, yet we find ourselves drowning in paperwork. When a patient is referred to an outside provider or hospital for a test, those test results come back to the office in the mail or by fax, both of which must then be scanned into the electronic health record before the provider can review the results with the patient. This cumbersome process adds cost to the system. Regulations need to be in place requiring all electronic health records and electronic dental records systems to effectively communicate with all other electronic vendors in the marketplace.

PHLN: Do you believe there is a connection between community health and public health?

Wollenzien: Yes, but I believe there should be an even greater connection between them. In most areas, we see very little cooperation between the public health department and the local community health center. I think this comes from competition and fear in the marketplace for certain patients. Public health relies on revenue from immunizations, health checks, women services, and so forth. Community health centers provide these same services. There should be a way to protect public health revenues while forging a relationship between the entities that benefit the community. Today’s system is designed for mild competition, which leads to suboptimization. Public health and health centers could benefit the community so much more if they worked together. Until the silos of competition and fear have been removed, however, I see little hope.

PHLN: What direction do you see community health taking in the future?

Wollenzien: Community health will remain an essential component of the overall healthcare delivery system in America. Communities caring for communities have been proven to produce incredible outcomes with limited resources. The community health center network across the country will continue to play a vital role in increasing the access to care for vulnerable populations. I’m hopeful that we’ll see more integration in the marketplace between public health and community health.

PHLN: How did you become a professor at Emory University’s Rollins School of Public Health, and how does that work connect with your work in a community health organization?

Wollenzien: I’ve always had the desire to teach. Early in my career, I spent three years learning quality improvement from William Scherkenbach. Mr. Scherkenbach, trained under Dr. W. Edwards Deming, is recognized as one of the world’s foremost authorities on quality and its implementation. During one of our sessions, he introduced Deming’s Theory of Profound Knowledge. The premise is that a leader must experience a personal transformation to effectively transform an organization to one that focuses on continual improvement. Once a leader goes through this transformation, he or she will be a good listener, continuously teach, never compromise, and help people move forward without feeling guilt from the past. After experiencing this transformation myself, I realized that I needed to be involved in teaching beyond our organization. Emory contacted me to teach its capstone Operations Management course, and I have now taught it for eight years, allowing me to meet more than 376 incredible young adults ready to take on the world. My whole career has been in healthcare operations. This class is an extension of what I’ve done in my career over the past 32 years.

PHLN: What role do you feel education plays in the development of comprehensive community health solutions?

Wollenzien: Education is critical—an educated community becomes a healthier community. Offering enabling services is part of what sets community health centers apart from the private marketplace. Enabling services focus on providing the individual patient and family with the essential tools and education required to live more healthy and productive lives. We learned years ago that all communities have their own unique problems. Conducting a comprehensive needs assessment allows us to identify the specific health and socioeconomic issues surrounding each community we serve. With this information, we can develop specific healthcare plans targeting both clinical and educational goals exclusive of another community’s needs.

Education is essential in the development and understanding of patient self-management goal development. Patients with chronic problems, such as hypertension, diabetes, asthma, and depression are asked develop a self-management goal sheet that they monitor continuously with their family members. Without effective education and understanding of their specific chronic problem, a patient would simply fall back into their old health habits. Once patients are educated about their conditions and demonstrate an understanding of the lifestyle changes they must make, you can then start to hold them accountable for improving their personal health status.

PHLN: Do you have any hobbies?

Wollenzien: In elementary school, all the kids were required to take a music class and learn to play the recorder. After that, I was hooked on music. In fourth grade, we could start learning a real instrument, so I tried the trumpet and played it in junior high and high school in the jazz and marching bands. In my senior year of high school, I formed a rock band with a few of my friends. We wrote all original tunes.

I didn’t play, write, or perform again for about 25 years. In 2010, I purchased a guitar and started taking lessons. Within two years, I had written seven original tunes and decided to record an EP. In 2012, I released my first studio recording, later released a live album, and am currently working on my next studio album.

PHLN: If you weren’t working in community health what do you think you would be doing?

Wollenzien: The only way I wouldn’t be working in a community health center is if it didn’t exist. My career took me away from community health centers. But, I was lucky enough to find my way back. I can’t think of anything that I’d rather be doing. All of the things in my life bring me joy. If I thought there were something else out there that would bring me joy, it would already be in my life.

PHLN: Have you read any good books lately?

Wollenzien: The only book outside of healthcare textbooks I am reading these days is the Bible. I start each morning with the Bible and find that I spend the rest of my time reading journals, periodicals, and newspapers to stay current with the healthcare environment. I think I’ll start a book this weekend!

Public Health Law News Quiz

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

Which organization is PHLP partnering with to host a webinar on June 21, 2017?

Public Health Law News Quiz Question May 2017 Winner!

Lisa A. Lang, MPP

Question: Which three Public Health Law Program externs contributed to the Public Health Law News during PHLP’s spring 2017 program?

Answer: Avae Thomas, MPH; Carrie Field, MPH; and Johanna Margeson, JD, MPH

Employment organization and job title: Assistant Director for Health Services Research Information and Head, National Information Center on Health Services Research and Health Care Technology, National Library of Medicine

Court Opinions

Delaware: Plaintiff’s light cigarette claims not preempted because they fall under state advertising law imposing general duty not to deceive, rather than smoking laws.
Carroll v. Philip Morris USA, Inc.
Superior Court of Delaware
Case No. 03C-08-167 AML
Filed 05/30/2017
Opinion by Judge Abigail M. Legrow

Florida: Businesses cannot benefit from stormwater flood systems or discharge stormwater into the system without paying stormwater utility fee
City of Key West v. Key West Golf Club Homeowners’
District Court of Appeal of Florida, Third District
Case No. 3D13-57
Filed 05/31/2017
Opinion by Judge Thomas Logue

Federal: Patients are not required to show adverse medical consequences to demonstrate that they have been denied the opportunity to participate in their own medical care under the Americans with Disabilities Act
Silva v. Baptist Health South Florida, Inc. [PDF – 171KB]
United States Court of Appeals for the Eleventh Circuit
Case No. D.C. No 1:14-cv-21803-KMW
Filed 05/08/2017
Opinion by Senior United States Circuit Judge David M. Ebel

Quote of the Month

Steven Waldren, director of the Alliance for E-health Innovation at the American Academy of Family Physicians

“I think that the key issue is, ‘Can I meet the standard of care with the level of tech I have in a virtual visit or not?’ And the doctor has to make that decision.” – Steven Waldren on liability concerns and standard of care for telemedicine.

[Editor’s note: This quote is from As telemedicine grows up, it needs some ground rules, Healthcare DIVE, 06/01/2017, by Shannon Muchmore]

About Public Health Law News

The Public Health Law News is published the third Thursday of each month except holidays, plus special issues when warranted. It is distributed only in electronic form and is free of charge.
The News is published by the Public Health Law Program in the Office for State, Tribal, Local and Territorial Support.

Subscribe!

Subscribe to Public Health Law News or access past issues. To make comments or suggestions, send an email message to phlawprogram@cdc.gov.

Disclaimers

News content is selected solely on the basis of newsworthiness and potential interest to readers. CDC and HHS assume no responsibility for the factual accuracy of the items presented from other sources. The selection, omission, or content of items does not imply any endorsement or other position taken by CDC or HHS. Opinions expressed by the original authors of items included in the News, or persons quoted therein, are strictly their own and are in no way meant to represent the opinion or views of CDC or HHS. References to products, trade names, publications, news sources, and non-CDC Web sites are provided solely for informational purposes and do not imply endorsement by CDC or HHS. Legal cases are presented for educational purposes only, and are not meant to represent the current state of the law. The findings and conclusions reported in this document are those of the author(s) and do not necessarily represent the views of CDC or HHS. The News is in the public domain and may be freely forwarded and reproduced without permission. The original news sources and the Public Health Law News should be cited as sources. Readers should contact the cited news sources for the full text of the articles.

Top of Page