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August 2012 - CDC Public Health Law News

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Hungry for School Lunch! Back to School Special Edition

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

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In this Edition

Announcements

Public Health Law and Ethics Course, August 27–December 5, 2012. The University of Vermont is offering a 3-hour online course examining the government's authority, at various jurisdictional levels, to improve the health of the general population within societal limits and norms. Professor William E. Wargo will teach the course from August 27 through December 5, 2012. The course is open to graduate, post-baccalaureate, continuing education students and professionals. Those interested in registering for the course should request instructor permission via e-mail at William.Wargo@uvm.edu. The last day to register for the course is August 31, 2012. For more information, registration assistance, and the course syllabus, please visit the Public Health Law and Ethics course page.


Call for Nominations: Foundations of Health Law. The American Society of Law, Medicine & Ethics (ASLME) and the Association of American Law Schools Section of Law, Medicine & Health Care seeks nominations of foundational works of scholarship in health law, very broadly defined, published in English before December 31, 2010. ASLME intends to publish an edited volume in an academic press. Nominations must be accompanied by a brief description, not to exceed 300 words, of the importance of the scholarly work, addressed to: Ted Hutchinson, Executive Director, American Society of Law, Medicine & Ethics, 765 Commonwealth Avenue, Boston, MA  02445. thutchinson@aslme.org. The first round of nominations will close on December 31, 2012. Find more information about the call for nominations.


Job Opening: ChangeLab Solutions seeks an attorney/vice president to lead its tobacco control programs. Applicants must be a have a JD and be a current member of a state bar in good standing, preferably in California. To apply please send a cover letter, resume, list of three references, and a pertinent writing sample via e-mail to jobs@changelabsolutions.org. Include "Attorney/VP—Tobacco Control Programs" in the subject line of the e-mail. Applications must be received by August 27, 2012. Find more information about ChangeLab Solutions and the Attorney/Vice President position.


Job Opening: The Michael & Susan Dell Foundation seeks an in-house attorney. The attorney will provide legal counsel for the Foundation in all of its charitable activities, including the childhood health portfolio [PDF - 143KB]. Applicants must have a bachelor's degree and JD from a US-accredited college or university and be admitted to practice in at least one US jurisdiction. The position is located in Austin, Texas. Find more information about the Michael & Susan Dell Foundation and apply for the position.


Detailed agenda available for the 2012 Public Health Law Conference. The detailed agenda for the 2012 Public Health Law Conference is now available. The Network for Public Health Law is hosting "2012 Public Health Law Conference: Practical Approaches to Critical Challenges," October 10–12, 2012 at the Loews Hotel in Atlanta, Georgia. Early registration at a discounted rate is open through September 12, 2012. The conference will include several concurrent sessions focusing on different public health law topics, such as prevention and promotion at the community level, changes and challenges to public health legal infrastructure, challenges to public health authority, and others. Find more information, read the agenda [PDF - 369KB] and register for the conference.

Legal Tools

The CDC Public Health Law Program is proud to announce the release of A Menu of Selected Provisions in Healthcare-Associated Infection Laws [PDF - 2.33MB], a resource for lawyers on state statutory provisions related to healthcare-associated infections (HAIs). The menu is released in tandem with The Emergence of Law to Address Healthcare-Associated Infections [PDF - 243KB], an overview for health lawyers who seek to understand the landscape of HAI laws and policies in order to advise healthcare clients, public health departments, and consumers regarding their responsibilities for HAI prevention. The article and menu were created through a partnership between CDC's Public Health Law Program and Division of Healthcare Quality Promotion, within CDC's National Center for Emerging and Zoonotic Infectious Diseases.


The Fluoride Legislative User Information Database (FLUID) is a comprehensive database cataloguing historical information about legal cases and policies in US courts and jurisdictions regarding community water fluoridation. FLUID was initiated and is funded by the Centers for Disease Control and Prevention Division of Oral Health. The database was completed by and is maintained through collaboration between the Health Law and Policy Program on Law and Government at the American University's Washington College of Law. Project staff research pertinent case law via Westlaw and other online legal search engines, and state and local policies are cataloged via various individual state policy databases and Municode. FLUID is updated regularly. Find more information and access FLUID.

The Council of State Governments has released its 2012 almanac of information about the states "The Book of the States." The book is available online and includes articles on topics such as state constitutional developments in 2011, Governors' state of the state addresses, and healthcare reform. Find more information and order a copy.

Top Stories

Massachusetts: Schools slow to provide head-injury records

The Boston Globe   (08/05/2012)   Lisa Kocain

Pursuant to a regulation passed in 2011, Massachusetts schools are required to report the number of students who sustained, or are suspected of sustaining, a head injury during a school athletic activity. While schools are required to report the number of concussions for the 2011-2012 school year, only 40 districts of about 430 have reported their numbers.

The reporting requirement is part of a larger program to track, reduce, and prevent brain injuries among youth. Failure to report could potentially undermine such efforts. Neal McGrath, a neuropsychologist and the clinical director of Sports Concussion New England described the need for reporting, saying "It's certainly a concern if schools are not following the law to report their numbers because that data is extremely important to us from a public health perspective, for us to understand the number of concussions schools are dealing with." McGrath's Brookline, Massachusetts practice provides concussion consulting to schools.

School administrators and officials have described various reasons for the lack of reporting, the primary reason being confusion about when the data is due, since the regulation has no fixed deadline. "The lack of a firm stated and enforced deadline is a concern to the [Massachusetts Interscholastic Athletic Association] MIAA. All of our regulations for instance, as you probably could guess, have strict deadlines," said Paul Wetzel, the MIAA's spokesperson.

Coaches and public health officials, however, remain hopeful for the regulation's success; "I think it will be useful in the sense that it might have coaches look at how they're conducting practices, how they're having equipment fitted," said athletic director and head football coach of Marshfield High School in Marshfield, MA, Lou Silva.

Lauren Smith, medical director for the Massachusetts Department of Health, is also optimistic. "I think we have to be prepared that over the next several years we might actually see an increase in the number of concussions that are reported. That doesn't mean that all of our hard work isn't paying off. It may just mean people are much more aware of what concussions are and how potentially life threatening they can be," said Smith.

[Editor's note: Read the Massachusetts regulation [PDF - 203KB] and Head Strong: Guidance for implementing the Massachusetts Regulations on head injuries and concussions in school athletics [PDF - 848KB], which was promulgated by the Commonwealth of Massachusetts Department of Public Health in January, 2012.]

Briefly Noted

California: Cease and desist orders allege non-doctors made medical decisions
Administrators ordered to stop making patient care decisions
California Watch   (08/06/2012)   Christina Jewett


Minnesota: Department of health releases alert for pertussis epidemic
Whooping cough cases on the rise
Detroit Lakes Online   (08/06/2012)   Anna Erikson


Ohio: Swine flu keeps some counties from going 'whole hog'
Swine flu concerns: Cuyahoga County Fair keeps pigs away for first time in history
Cleveland.com   (08/06/2012)   Brandon Blackwell


Ohio: Injured woman challenges state's definition of 'spectator at equine event' 
Woman injured by horse fights state law limiting lawsuits
Vindy.com   (08/05/2012)


National: American Bakers Association opposes proposed sugar reporting
Bakers oppose FDA research into labeling of added sugars
Food Navigator USA   (08/03/2012)   Caroline Scott-Thomas  


National: Aurora shooting brings questions of therapists' duty to report patients
Therapists walk fine line in reporting violent plans
CNN   (08/02/2012)   Danielle Dellorto


National: Medical tech charged, potentially infected patients await tests
Thousands await testing for hepatitis by 'infector'
New York Times   (08/01/2012)   Katharine Q. Seelye


National: Tax loopholes for cigars may drive shift in smoking habits
Tobacco companies profit from loophole, market small cigars
USA Today   (08/06/2012)   Liz Szabo


China: Authorities detain nearly 2,000 in national counterfeit drug sting
China's fake drugs crackdown results in arrests of nearly 2,000
Huffington Post   (08/05/2012)

Feature Profile in Public Health Law: Sheri Ottersen

Title: Director of Child Nutrition

Organization: Osborn Elementary School District, Phoenix Arizona

Education: BS Foods and Nutrition


CDC Public Health Law News (PHLN): Please describe your duties and responsibilities as the Director of Child Nutrition.

Ottersen: I am responsible for the overall operations of the Food Services for Osborn School District. Duties include administration of the National School Meal Program, ensuring compliance with all state, federal, and local regulations, and responsible for all financial aspects associated with running a cost effective business.

PHLN:What was your route to child nutrition, in terms of education and career path?

Ottersen: I began my management career in the food and beverage industry in restaurants. Determining that there had to be more to life, I returned to school, finished my BS in Foods and Nutrition with a minor in Business. I first landed a job at a hospital where everything was life or death. I then moved into a corporate setting with a national contract food service company. The travel was exciting, but didn't feel as though it made much overall impact. About 15 years ago I answered an ad in the newspaper for a position with a school food service. After the initial shock of the salary wore off, I convinced myself that I could make a difference, as well as enrich my own life. I have had no regrets.

PHLN: Please describe your school district (i.e. how many schools, what type of schools, the percentage of children enrolled in the free or reduced lunch program, how many meals and what type do you provide daily?).

Ottersen: Our school district is a perfect size in which to implement change. The District consists of five schools: one K-3, one 4–6, two K–6 and one 7–8 and is located near down town Phoenix, Arizona. Ninety percent of all of the students eat meals served in our cafeterias. Breakfast, lunch. and after-school snacks are served daily. Students attending our schools are from all backgrounds. Statistically, 88% qualify for free or reduced meals.

PHLN: Do you see yourself as working in the area of public health law?

Ottersen: Yes and no...I understand the importance of the role that school nutrition plays in the overall health of our public, but most days, the enormity of the tasks at hand keeps me focused on the moment and sometimes not on the bigger picture.

PHLN: Your program has been hailed as an innovator in your community, creating a program that engages children in nutrition education. Will you please describe some of the activities and resources you use to teach children about nutrition?

Ottersen: About five years ago, I concluded that providing meals to children in a large setting such a school cafeteria at lunch time is not effective in trying to change eating habits. Most of the healthier offerings went in the trash. I thought if I had the chance to reach them in smaller groups, we could actually have discussion and the ability to offer new foods without any risk on their part. I had observed kids passing up unfamiliar items because if they took them and didn't like it, they would risk hunger later in the day.

There existed a small space that had been used for storage with an abandoned dish room next door. This, I thought could be turned into The Garden Café. The space was reconfigured to include a small kitchen and seating area. The seating area has restaurant style tables and booths. The large windows look out over the sky line of down town Phoenix. Students come there to try new items, learn about nutrition and exercise and sometimes just talk about food. The space is also equipped with a demonstration and preparation area that students can actually make simple recipes. Parents and staff are also invited. We have had classes offering suggestions for healthy meals, shopping tips and nutrition information. On occasion, the Café hosts District meetings, where all meals include a brief nutrition lesson or discussion regarding a health related topic.

PHLN: A lot of focus is placed on the concept of "offering" rather than serving food to children. What do these terms mean and how does "offering" food modify your program? Where did the shift in terminology come from?

Ottersen: The terminology has been used in describing the method of service for school meals for a while. Osborn Schools have participated in the "offer" option, offering a number of foods from the food groups for children to select themselves. I believe that when students are given healthy options, it begins to teach them about nutrition. The Serve option is a pre-plated meal with required amounts. It has been my experience that this creates waste. For success, only good choices are available. The purchase of extra à la carte items has never been a part of our program.

PHLN: How does the Choose My Plate program relate to offering food to children?

Ottersen: The My Plate is more easily understood than the My Pyramid. It is a nice reminder and works well as a teaching tool.

PHLN: The new federal school meal requirements [PDF - 276KB] will be implemented during the 2013–2014 school year. How is your district preparing for the changes? Do you anticipate any challenges?

Ottersen: We are already there, with just a few adjustments. Serving the fruits and additional vegetables were not a problem at all. Offering whole grains were what we have been doing. The most difficult part of the whole process has been making the switch back to a component based meal pattern from analyzing all of the food items that we served. We are at an advantage; many of our menu items are made from scratch, with limited ingredients.

PHLN: As your program is already implementing many of the pending changes, what, if any, results do you expect to see from the new requirements?

Ottersen: That is hard to predict.

PHLN: How did your program become so advanced with regard to compliance with the new nutrition requirements?

Ottersen: My staff and I eat in our cafeterias daily. It is the way I would feed my own children.

PHLN: Do you have any advice for communities or school districts that are struggling to meet the new standards?

Ottersen: Change starts with a positive attitude and a willingness to change. I would advise using all of the resources available to schools and if that is difficult, emulate a successful existing program. Many school district food services combine resources and share regularly with one another.

PHLN: If you were not working in public health law, specifically in the area of child nutrition, what would you likely be doing?

Ottersen: Maybe writing cookbooks or food photography—wait, I do that now. I think that I have the perfect job!

PHLN: Describe any personal information, hobbies, or interests you care to share.

Ottersen: Of course, I love to cook. I mentioned photography. I would love to garden more.

PHLN: What are your favorite books and what have you read lately?

Ottersen: Reading books this summer was replaced by reading the new regulation manuals. J

PHLN: Is there anything else you'd like to add?

Ottersen: I would only like to add that I am encouraged by all of the attention that food has gotten lately. I believe that education is the key. I would really like to see nutrition and food science woven into all curriculum taught in schools.

Feature Profile in Public Health Law: David Binkle

Title: Interim Food Services Director

Organization: Los Angeles Unified School District (LAUSD)

Education: Bachelor of Science, Oklahoma Panhandle State University; Culinary skills from the Culinary Institute of America, Hyde Park, New York; Currently completing a Master of Public Administration (MPA) from California State University, Northridge-Tseng College

Number of children in district (K-12 Enrollment): 664,233

Number of meals served daily: 650,000

Free or reduced priced meal eligibility: 80.47%

Average cost per meal: $2.49 (FY 2010; includes food, food supplies, labor and benefits, and other operating expenses)


CDC Public Health Law News (PHLN): What was your route to child nutrition, in terms of education and career path?

Binkle: I am a Certified Executive Chef, Certified Culinary Administrator and Certified Executive Pastry Chef with more than 30 years of experience as a senior food service administrator, corporate chef, culinary arts instructor and food services director. Prior to joining LAUSD, I was Director of Dining Services at California State University, Fresno and have worked for the Dallas and Duncanville, Texas school systems, Morrison Restaurants Inc., and the International Culinary School at the Art Institute.

PHLN: Please describe your duties and responsibilities as Interim Food Service Director, Mr. Binkle.

Binkle: At LAUSD, I oversee menu and compliance areas within the division, ensuring the District stays at the forefront of national, state, and local food policies and procedures.

PHLN: Do you see yourself as working in the area of public health law?

Binkle: I do. I work to follow local, state, and federal law to receive funding reimbursement for the school meals program at the District. LAUSD certainly sees their work in the area of food procurement as helping to advance public health law and strategies designed to address childhood obesity in the County of Los Angeles.

PHLN: In the past decade, LAUSD's school nutrition program has become something of a rags-to-riches story; first being lambasted by the media and the community and now largely being regarded as one of the most advanced and comprehensive school nutrition programs in the country. What was the strongest motivator for improving school nutrition within the district?

Binkle: Ensuring health and good nutrition are key priorities for LAUSD. Over the last decade, the Los Angeles Unified School District's Board of Education and district administration have led efforts nationwide in promoting access to healthy food in the school meals program including increasing access to fresh fruits and vegetables, reducing sodium levels and added sugars in its foods, and banning sodas and other drinks high in sugar.

PHLN: What did LAUSD identify as their greatest problem areas? How were those areas identified and addressed?

Binkle: The greatest challenge we face is having all students, parents and other community stakeholders embrace the new healthier menu items. LAUSD has conducted student and parent tastings, partnered with LAUSD Parent Centers, held meetings with parents and other key stakeholders, and participated in School Board meetings to gain continuous feedback on the new school menu.

PHLN: LAUSD is one of the largest school districts in the country. How does your great size help and hinder LAUSD's ability to provide nutritional school meals?

Binkle: The size of the District does not hinder LAUSD's ability to provide nutritional school meals. Its size and purchasing power allows the school meals program to procure larger volumes of food, have greater distribution and operational support, employees, management, and increased visibility.

PHLN: What role has law played in the LAUSD's school nutrition?

Binkle: School nutrition policies at every level of government are the founding framework for what LAUSD works to improve nutrition and to comply with requirements under the National School Breakfast and Lunch programs. The recent changes to the USDA school meal nutrition standards have provided a significant opportunity and momentum for LAUSD to continue improving the nutritional quality of our menus.

PHLN: How are LAUSD and LAC DPH working together in the area of school nutrition to implement the new laws?

Binkle: In 2010, the District partnered with the Los Angeles County Department of Public Health (DPH) on our efforts to promote healthier menu offerings in the 2011–12 school year. This partnership included funding to promote the new menu, including the launch of the District's "I'm In" campaign, which aims to promote healthy food options to students. The partnership also helped support the development of signage and materials and a comprehensive evaluation of the new menu to assess the nutritional changes, food selection patterns and plate wastage by students. These results will be released in the coming months. DPH is committed to working with LAUSD, students, parents and other key stakeholders to ensure that the nourishing, appetizing choices available on the LAUSD menu are effectively served, promoted, and enjoyed.

PHLN: What changes does LAUSD anticipate making with regard to the new Choose My Plate and federal school meal requirements [PDF - 276KB], which take effect during the 2013–2014 school year?

Binkle: The district will be working to implement new USDA school meal standards, such as calorie limits, a greater quantity and variety of vegetables, and a requirement that students select a fruit or vegetable. The District will also be working to train and educate cafeteria staff and the community on these changes.

PHLN: What are some of the most effective or most popular changes you have made? The most rewarding?

Binkle: Changing the perception of the school meals program from a program that serves lower quality food to an environment offering fresh healthy menu items has been a significant change and achievement. The most rewarding aspect of this work is to know that obesity levels in the County of Los Angeles are leveling off and policy interventions implemented at LAUSD among other County-wide strategies are potentially playing a part in this effort.

PHLN: As previously mentioned, LAUSD has a great deal of negotiating clout within the local food market because of its enormous size. How can smaller districts encourage change in their own markets?

Binkle: By championing and taking courageous steps to change your school menus.

PHLN: Do you have any other advice for communities or school districts that are struggling to meet the new standards?

Binkle: Build key stakeholder capacity to champion, support, and stay the course on improving your program.

PHLN: If you were not working in public health law, specifically in the area of child nutrition, what would you likely be doing?

Binkle: I would be working in the restaurant business.

PHLN: Describe any personal information, hobbies, or interests you care to share.

Binkle: I enjoy cooking and regular physical fitness.

PHLN: What are your favorite books and what have you read lately?

Binkle: I am currently reading The Five Dysfunctions of a Team.

PHLN: Is there anything else you'd like to add?

Binkle: This work wouldn't be possible without support and collaboration with multiple community organizations including California Food Policy Advocates, the Urban and Environmental Policy Institute, the Los Angeles Food Policy Council, the LA Fund for Public Education, and the District's category food supply partners on the development, coordination, and promotion of the District's new school menu.

Court Opinions

New Jersey: State Board of Mortuary Science has authority to amend rules
In the matter of Challenge of New Jersey State Funeral Directors Association
Docket No. A-0177-11T2
Superior Court of New Jersey, Appellate Division
Decided July 26, 2012
Opinion by Judge Jane Grall


Federal: Complaint dismissed in case of alleged defamation in medical journal
Harkonen v. Fleming
Case No. C 12-1267 SI
United States District Court for the Northern District of California
Decided July 24, 2012
Opinion by District Judge Susan Illston


Federal: Preliminary injunction granted in private business' ACA women's coverage challenge
Newland v. Sebelius
Civil Action No. 1:12-cv-1123-JLK
United States District Court, District of Colorado
Filed July 27, 2012
Order by District Judge John L. Kane


Federal: Board of health off the hook in seafood condemnation case
Comeau v. Town of Webster
Civil Action No. 11-40208-TSH
United States District Court for the District of Massachusetts
Decided July 24, 2012
Opinion by District Judge Timothy S. Hillman


Federal: Summary Judgment upheld for destruction of blood and saliva samples case
On-Site Screening, Inc. v. United States
Civil Action No. 11-2895
United States Court of Appeals for the Seventh Circuit
Decided July 25, 2012 Opinion by Judge John Daniel Tinder

Quotation of the Month

Tim Fowler, President of the Cuyahoga County Fair Board, Berea, Ohio

"We do regret the decision, but we definitely think it is in the best interest...There are other animals here. There's still plenty to see at the county fair," Tim Fowler said of the Cuyahoga County Fair Board's proactive decision to ban pigs from the county fair.

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The CDC 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 CDC Public Health Law Program in the Office for State, Tribal, Local and Territorial Support.

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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 CDC Public Health Law News should be cited as sources. Readers should contact the cited news sources for the full text of the articles.

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