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March 2013 - CDC Public Health Law News

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In this Edition

Announcements

Eleven Public Health Departments First to Achieve National Accreditation. The Public Health Accreditation Board (PHAB) awarded 5-year accreditation to 11 public health departments on February 28, 2013. The national program, jointly supported by the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention, aims to improve and protect the health of the public by advancing the quality and performance of the nation’s state, tribal, local and territorial public health departments. Find more information about accreditation and the accredited public health departments [PDF - 253KB].


Study finds public support for legal interventions to fight obesity, noncommunicable diseases. According to a new Harvard School of Public Health (HSPH) study, the public is very supportive of government action aimed at changing lifestyle choices that can lead to obesity, diabetes, and other noncommunicable diseases, but is less likely to support such interventions if they are viewed as intrusive or coercive. The study was co-authored by Stephanie Morain, a doctoral candidate in health policy at Harvard University, who lead the study, and Professor Michelle Mello, professor of law and public health in the HSPH Department of Health Policy and Management, appears in the March 2013 issue of Health Affairs. Find more information and read the study.


Call for proposals for Excellence in State Public Health Law program. The Justice and Society Program, with funding from the Robert Wood Johnson Foundation, has announced a new Excellence in State Public Health Law (ESPHL) program. The one-year ESPHL program will consist of up to eight teams of eight members each. Over the course of the year, each team will focus on exploring, identifying, and evaluating how law and policy can advance one of their respective state’s health priorities. The goal of the ESPHL program is to provide education and other resources that will enable policymakers and agencies to more effectively address public health issues and to become leaders in creating healthier states. The program will strengthen public health law collaborations among state officials and state-level policy-makers, and will increase these leaders’ effectiveness on public health issues in their respective states, including working across party lines and government agencies and branches. The first phase of applications is due April 16, 2013. Find more information and read the full call for proposals [PDF - 453KB].


Lecture highlighting important role of boards of health. The 14th Annual Ned E. Baker Lecture, Leading the Way to Healthier Communities: How Leadership Can Strengthen Public Health, will take place on April 4 from 4:00 to 5:30 pm (ET) in Bowling Green, Ohio. Participants will explore the dynamic characteristics of leadership and learn how board of health members, public health professionals, elected officials, and community members can exhibit leadership that improves the health of communities. Find more information about the Ned E. Baker Lecture and be a part of the live, interactive webcast.


Food law job opening at the UCLA School of Law. The UCLA School of Law is seeking a highly energetic, experienced individual to be the Executive Director of a newly established Program for the study and practice of food law and policy located at the UCLA School of Law. The Program is designed to bring world class policy analysis, research, and educational opportunities in food law and policy to UCLA Law School, the campus, the broader community of Southern California, the nation, and the world. Minimum requirements include an excellent academic record; a J.D., M.B.A., or equivalent advanced degree from a U.S. school; at least five years of successful food law and policy practice or experience; demonstrated management, administrative, and organizational skills, with successful prior experience in fundraising or coordinating scholarly or professional conferences preferred; prior successful teaching experience and a record of publications concerning food law and policy topics preferred; a strong record of established relationships with other food law and policy professionals and with professional organizations preferred. Confidential review of applications, nominations, and expressions of interest will begin immediately and continue until an appointment is made. Send a résumé, cover letter, and the names and addresses for at least two professional references to the attention of Edna Sasis, Office of the Dean, UCLA School of Law, 405 Hilgard Avenue, Los Angeles, CA 90095-1476. Email applications may be sent to sasis@law.ucla.edu. Find more information about the Executive Director position.


ASLME Health Law Professors Conference. The American Society of Law Medicine and Ethics (ASLME) is happy to announce the 36th Annual Health Law Professors Conference will be held June 6–8, 2013, in Newark, New Jersey. The conference will be co-sponsored by ASLME and Seton Hall University. Find more information about the conference.


NALBOH Annual Conference. The National Association of Local Boards of Health (NALBOH) is hosting NALBOH 21st Annual Conference, Responsible Governance for a Brighter Public Health Future, which will take place August 14–16, 2013 in Salt Lake City, Utah. The conference will provide board of health members and other public health professionals with information on public health governance functions, engaging citizens, and the role of effective leadership in healthy communities. Registration will open April 20, 2013. Find more information about NALBOH and the 21st Annual Conference.

Legal Tools

50-state legislative tracking system from ASTHO. The Association of State and Territorial Health Officials (ASTHO) State Health Policy team provides research, technical assistance and opportunities for the state health agency legislative liaisons to exchange ideas on public health policies. The State Health Policy team tracks and analyzes legislation, regulations and executive orders across the states. Activity at the state level is tracked through an electronic 50-state legislative tracking system, news from publications and other professional organizations, and communication with ASTHO members. ASTHO provides the resources to assist state health agencies and others in understanding national trends and emerging issues impacting public health and state health agencies. Find more information and access the 50-state legislative tracking system.


Public health and information sharing toolkit. The Association of State and Territorial Health Officials (ASTHO) has published The  Public Health & Information Sharing (PH&IS) Toolkit, which addresses key concepts regarding public health agencies' authority to collect, use, and share information to prepare and respond to a public health emergency. The toolkit addresses information sharing issues in general and when information sharing involves the workplace or law enforcement. The toolkit's component documents are designed to assist in education, training, and planning activities to prepare for emergencies, as well as to serve as a quick reference resource during an emergency response to an event. The PH&IS Toolkit is one of six toolkits in ASTHO's Legal Preparedness Series. Find more information and access the toolkit.


Catalogue of state bullying laws and bullying prevention toolkit. In December 2010, the U.S. Department of Education (DOE) reviewed state bullying laws and identified 11 key components common among many of the laws. Bullying, cyber bullying and related behaviors may be addressed in a single law or may be addressed in multiple laws. In some cases, bullying appears in the criminal code of a state that may apply to juveniles. A catalogue of the laws may be found at Stopbullying.gov, a website managed by the U.S. Department of Health and Human Services. DOE has also released a free two-part training tool kit designed to reduce incidents of bullying for use by classroom teachers and educators. Find more information about state bullying laws and access the bullying prevention toolkit.

Top Stories

New York: Judge halts New York City soda ban

Wall Street Journal   (03/11/2013)   Michael Howard Saul

New York City’s regulations banning the sale of sugary drinks over 16 oz. were enjoined on March 11, 2013 by New York Supreme Court Judge Milton Tingling. The regulations, which would have taken effect on March 12, 2013, would have allowed the city to fine vendors $200 per sale of oversized sugary drink after a three-month grace period.

Judge Tingling wrote that the regulations were “fraught with arbitrary and capricious consequences . . .” and that “[t]he simple reading of the rule leads to the earlier acknowledged uneven enforcement even within a particular city block, much less the city as a whole . . . the loopholes in this rule effectively defeat the state purpose of the rule.”

The regulations, unique and new type of rules in the escalating conflict surrounding the nation’s weight and diet, were passed by the New York City Board of Health in 2012. The regulations applied to restaurants, bars, movies theaters, and other venues, which are regulated by the city, but not convenience stores or supermarkets, which are regulated by the state.

New York City Mayor Michael Bloomberg proposed the regulation and has been one of its most vociferous advocates in the anti-obesity effort. Consumers are not wholly supportive of the new soda regulation and are skeptical of its efficacy. “It’s ridiculous to put this kind of money and legislation into something people are going to find a way to bypass,” said forty-six-year-old Dante Nero of New York City’s Brooklyn borough.

Mayor Bloomberg’s other public health regulations, such as bans on smoking in bars and lowering transfats in restaurants, were also met with doubt, but have become more popular since their implementation.

[Editor’s note: Find more information about New York City’s sugary soda regulations [PDF - 374KB], read the regulations [PDF - 322KB], and read the New York Supreme Court opinion.]


International: A decade after devastating outbreak, is the world better prepared for next SARS? 

Canada.com   (03/07/2013)   Helen Branswell

In 2003, Asia reported the first cases of severe acute respiratory syndrome (SARS), a viral respiratory illness caused by a coronavirus. Within a matter of months, the virus had spread to four continents, including North America, and more than two dozen countries had reported instances of the illness before it was contained. The speed and severity with which the illness struck and spread throughout the global economy brought new understanding of how the world must respond to threats of new infectious diseases.

Under the rules of the World Health Organization (WTO), national governments are responsible for reporting the severity of the contagion to the WTO. Due to lack of infrastructure, Canadian federal officials were unable to receive accurate numbers regarding the SARS outbreak in Toronto, Ontario, though it was the only large SARS outbreak outside of Asia. Since the SARS epidemic, many governments and health organizations have created laws, infrastructures, and systems for dealing with and responding to infectious diseases on a global scale. In Ontario, Canada, tracking the disease and allowing the information to flow to the correct parties presented an enormous challenge. “We don’t have to work with sticky notes on a board. We’ve got information systems. We’ve got very skilled staff who are able to manipulate that data and turn it into reports right away, and get those out in pretty well real-time to our public health partners. That kind of capacity . . . did not exist in Ontario at the time of SARS,” said Dr. Vivek Goel, a public health physician, President and CEO of Public Health Ontario, an organization created because of the SARS outbreak.

“The world’s better prepared to respond, because they’ve had experience in it. They’re not better prepared with vaccines, because there isn’t a [production] platform that you could easily slip a new antigen into and get a vaccine out of,” says Dr. David Heymann, professor of infectious diseases epidemiology at the London School of Hygiene and Tropical Medicine and head of the Center for Global Health Security at Chatham House (home of the Royal Institute of International Affairs).

[Editor’s note: Find more information about SARS, read the SARS Commission Final Report, written by the Commission to Investigate the Introduction and Spread of Sever Acute Respiratory Syndrome, created by the Government of Ontario in June 2003. Read the CNN news article about a new SARS-like virus reported by the Saudi Health Ministry to the WTO in late February 2013.]

Briefly Noted

California: Sex offenders remove GPS tracking and circumvent new laws
More California sex offenders go missing under prison realignment
CBS   (03/07/2013)
[Editor’s note: Find more information and read California’s new law enforcement legislation.]


Florida: Doctors not required to check prescription database
Nassau sheriff says drug database is underused
Fox News   (03/08/2013)   Dee Registre
[Editor’s note: Learn more about Florida’s prescription drug database and read Florida Code Section 893.055.]


Maine: Radon testing law not enforced in the four years since enactment
Landlords favor new radon law
Portland Press Herald   (02/18/2013)   Kelley Bouchard


Ohio: Concussion law will include parental consent and education
Ohio’s ‘Youth Concussion Law’ goes into effect in April
NBC WKYC   (02/12/2013)   Monica Robins


Washington: State allows private liquor sales, small business compete with distributors
Rule in state law making it tough for smaller liquor stores
Herald Net   (03/10/2013)   Jerry Cornfield


National: Army task force reviews PTSD diagnoses and treatment protocol
Army task force calls for improving care of soldiers with PTSD
Seattle Times   (03/08/2013)   Gene Johnson


National: TSA focuses on explosives, allows small knives
Despite opposition, TSA sticks with decision on knives
CNN   (03/11/2013)   Mike M. Ahlers
[Editor’s note: Find more information about the Transportation Security Administration’s updated prohibited items list.]


 National: ‘Essential health benefits’ include mental health and addiction treatment
‘Essential health benefits’
The Progress   (03/13/2013)   Steve Gularte


National: New preventative food safety rules open for comment until May 4, 2013
FDA’s strategic shift from reaction to prevention
Food Safety Magazine   (03/05/2013)   Angela Spivey
[Editor’s note: Find more information and read FDA’s proposed rules.]

National: Concerns over laws regarding genetically modified food ingredient reporting
Genetically modified foods: Who has to tell?
Los Angeles Times   (02/23/2013)   Rosie Mestel


National: Mental health parity required since 2008, requirements unclear
Since 2008, insurers have been required by law to cover mental health—why many still don’t
The Atlantic (03/11/2013)   Judith Graham


China: Police work to stop illegal sale of meat from sick pigs
2,800 pigs dumped in Shanghai River raise health concerns
Fox News   (03/11/2013)

Feature Profile in Public Health Law

Tim Miller

Title: Environmental Health Director

Organization: Mid-Ohio Valley Health Department, West Virginia

Education: West Virginia University at Parkersburg


CDC Public Health Law News (PHLN): What initially sparked your interest in public health, and, more specifically, public health laws and regulations?  

Miller: Before I started into public health, I was a business owner in the private sector. I owned a group of food stands, and operated them daily. This was a seasonal business, and, as such, was not sufficient income to support my growing family. This is where I first learned about public health and the day-to-day impact that environmental health has.

PHLN: What was your career route to the Mid-Ohio Valley Health Department (MOVHD) in terms of education and career choices?

Miller:  I finished my bachelor’s degree in 2000, and, while working on it, had started my own food business. After doing that for a few years, I learned about state government and the benefits available for employees. Also, the health inspector that was my inspector told me about a position that would be available at the health department, so I applied. I started with MOVHD in December 2003.

PHLN: Please describe your projects and activities at MOVHD.

Miller: I’ve worked the field as a sanitarian; I also went through the Southeastern Public Health Leadership Institute (SEPHLI) and gained a great deal of public health knowledge from this great experience. My project for SEPHLI was an attempt to regionalize the entire state of West Virginia’s health departments. I used our own agency as a pattern. With this project, I had a projected savings of over $1 million per year in public health money that could be put back into the state to further public health for West Virginians.

PHLN: Why is law an important aspect of local health departments’ mission and goals?

Miller: We here at MOVHD use public health laws to gain compliance. We make every attempt to get compliance without having to use the legal system. If a person won’t comply as we’ve asked, after due notice, then we file charges against them in Magistrate Court. Public health law is very important in enforcement of regulations. I feel that without the laws backing health departments, there would be very little compliance of the rules.

Law and policy have another function. Our food handler regulation is an example of a policy or law that improved the average quality of food establishments in our region. Through this regulation, at least one employee has to be certified in food safety [PDF - 124KB], which is not an easy certification to achieve.  Food code violations decreased significantly after it was enacted, and it was because employees in those establishments were better educated on how to run a safe food establishment. So, law and policy is a tool to improve public safety.

PHLN: In recent years the U.S. has suffered through several food contamination crises. MOVBH passed the MOVHD Food Handler Regulation [PDF - 31KB] (“Food Handler Regulation”), a policy requiring restaurants to have someone on staff with a food safety certification. Why was the Food Handler Regulation created?

Miller: This was created to try to reduce the possibility of foodborne outbreaks. We also felt that if the leaders weren’t educated, how we could expect them to be able to train people the correct way to handle food properly? The regulation was an effort to educate people in food handling.

PHLN: You played an integral role in drafting the Food Handler Regulation; will you please describe the drafting process and what tools you used?

Miller: We used the Clean Indoor Air regulation that our Board of Health had passed as a model for this regulation. We simply crafted it to be about food handlers. The regulation was a collaborative effort with several sanitarians, as well as the executive director and a couple of Board of Health members. After the regulation was written, it went to the board as a whole for revision. They made a couple of changes to fit the way they felt it should be, and the result is what you have seen: a fairly great way to educate individuals in the handling of food.

PHLN: How did MOVHD decide the Food Handler Regulation was the most appropriate tool for furthering the board of health’s goals?

Miller: It took great discussion, and thought from the members of the committee about the whole process. But, in the end, we convinced the Board of Health that this was the best way to reduce violations in our food establishments, and also, possibly, reduce the possibility of foodborne illness in our six-county region.

PHLN: How did restaurants implement the food safety certification policy? What role did MOVHD play in assisting in the policy’s implementation?

Miller: MOVHD held many food handler trainings, and had large classes for food handlers. We made every effort to let everyone know what was expected of them. We gave them plenty of time to get their people trained, and made multiple trainings available. We use online training as well as classroom training.

PHLN: What effect has the policy of having someone on staff with a food safety certification had upon instances of food contamination in MOVHD’s jurisdiction?

Miller: We have a very low rate of confirmed foodborne illness. The policy has done more to lower cited violations of the food code than anyone expected. The policy has really helped to educate people and has shown us in the true numbers that education is the key to food safety. Our critical and non-critical violations are both at about one-third of the level they were before the policy was enacted.  That’s a huge reduction. (Critical item: means a provision of the Food Code, which, if in noncompliance, is more likely than other violations to contribute to food contamination, illness, or environmental health hazard.)

PHLN: Were there any unexpected results from the policy’s implementation?

Miller: I think the surprising, while maybe not unexpected, results were how quickly we saw results from decreased violations of the food code. The results were actually immediate. The first year, violations were down dramatically. I think we will continue to se a drop in violations as we go further into this.

PHLN: Has MOVHD made any other recent changes to its food safety laws?

Miller: Probably the next biggest change that was made was allowing a credit to retail food service permit fees for establishments that carry fresh fruits and vegetables. For each fresh fruit or vegetable type that a retail establishment carries, they are allowed a credit of $25 per year towards their food service permit fee. So, for example, if they carry four types of fruits and vegetables, they can earn as much as $100 off of the permit fees for their establishment.

PHLN: Do you have any advice or suggestions for other local health departments seeking to write and implement similar regulations?

Miller: These types of regulations take time to craft. We spent hours working though this one. It takes buy-in from the Board of Health as well as staff. I feel that the time and effort was well worth it, and we would do it all over again, if needed. Also, the key to implementation in our region is time. Once the regulation was passed, we allowed a month for all establishments to come into compliance. We did this for two reasons: 1) we couldn’t get everyone trained that needed to be, and 2) we felt it reasonable to allow a long phase-in period to get everyone into compliance.

PHLN: Are you working on any other exciting public health law projects?  

Miller: MOVHD is always looking for ways to improve the safety and security of our region, making things better for the communities we serve. Examples of something we are working on that we think is pretty exciting is our approach to the obesity epidemic from an oral health standpoint. In West Virginia, Medicaid only pays for emergency extractions. Yet we allow Supplemental Nutritional Assistance Program (SNAP) recipients to purchase soda with their benefits; maybe up to 10% of SNAP benefits in West Virginia are spent on soda. We based this percentage on a 2012 study published by Yale University’s Rudd Center for Food Policy and Obesity, Grocery store beverage choices by participants in federal food assistance and nutrition programs.

Though the study only looks at grocery store SNAP expenditures, West Virginia also allows SNAP expenditures in convenience stores. We used the data available from this study to estimate the percentage of West Virginia SNAP benefits being spent on sugary beverages in grocery stores as well as convenience stores. More sugary beverages are purchased in convenience stores than any other beverages and, according to data comparisons with the study, more sugary beverages are sold in convenience stores than in grocery stores. Given this information regarding sugary beverage sales in grocery stores and convenience stores we feel that ten percent is a conservative estimate of the amount of the total West Virginia SNAP benefits being used to purchase sugary beverages, and actual percentage could be much higher.

We have research that shows continual sipping on these acidic beverages is very harmful to teeth.  Citric acid based beverages, such as Mountain Dew, are over five times more erosive than the acids in colas. So, continually sipping these beverages causes many of the problems we see in our low-income dental clinic. 

MOVHD is also considering passing a policy requiring a warning to be posted at all venues in our region where soda is purchased warning of oral health damage due to continual sipping. If such a policy is implemented, we’ll try to measure consumption patterns before and after the warnings to show if we can change consumption patterns of consumers. Soda is linked with obesity, and if we can change consumption patterns with a campaign like this, then we have likely impacted obesity and health, too. A policy like this could be easily be adopted by other local health departments across the country.

PHLN: If you weren’t working in public health law, what would you likely be doing?

Miller: I’m sure that I’d still be on the other side of this, selling food, and being regulated by the health department in some way.

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

Miller:  I have an amazing wife who understands what and why I do the things I do here at MOVHD. She’s very passionate about people. We love to travel, although we don’t get to as much as we’d like. Our children know and understand what we do, and are very supportive in many ways.

PHLN: Have you read any good books lately?

Miller: I’m a reader of political books. The last good book I read was by President George W. Bush, Decision Points. It was interesting reading about a time in our lives that I could remember, and a very changing time. I love to read about the behind the scenes stories of our leaders.

Court Opinions

Illinois: Village water contamination excluded from insurance coverage
The Village of Crestwood v. Ironshore Specialty Insurance Co., Westport Insurance Corp., and United Nat’l Insurance Co. [PDF - 102KB]
Appellate Court of Illinois, First District, Fifth Division
Case Nos. 1-12-0112 & 1-12-0227, consolidated
Filed 02/22/2013
Opinion by Judge Margaret Stanton McBride


Maine: Case remanded for application of law limiting wind farm sound levels
Friends of Maine’s Mountains v. Board of Environmental Protection [PDF - 165KB]
Supreme Judicial Court of Maine
Case No. BEP-12-137
Decided 03/05/2013
Opinion by Justice Warren M. Silver


Pennsylvania: Counselor’s discharge did not violate Pa. Code or ACA Ethics
Mikhail v. Pennsylvania Organization for Woman in Early Recovery D/B/A POWER [PDF - 13KB]
Superior Court of Pennsylvania
Case No. 387 WDA 2011
Filed 02/27/2013
Opinion by Senior Judge Eugene B. Strassburger, III


Federal: Festival’s permit revocation may have denied procedural due process
Ihnken v. Gardner [PDF - 73KB]
United States District Court, District of Maryland
Case No. CCB-11-3508
Filed 02/27/2013
Opinion by Judge Catherine C. Blake


Federal: County cannot recover airplane crash clean-up expenses
County of Erie, New York v. Colgan Air, Inc. [PDF - 35KB]
United States Court of Appeals, Second Circuit
Case No. 12-1600-cv
Decided March 4, 2013
Opinion by Judge Richard C. Wesley

Quotation of the Month

Michael Taylor, the United States Food and Drug Administration’s (FDA) deputy commissioner for foods and veterinary medicine comments on the FDA’s new rules to prevent food contamination.

 “We’re taking a big step for food safety by proposing the standards that will help us prevent food safety problems rather than just reacting to them,” said Michael Taylor.

About Public Health Law News

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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