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September 2013—CDC Public Health Law News

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Thursday, September 19, 2013

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Office for State, Tribal, Local and Territorial Support,
Centers for Disease Control and Prevention

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In this Edition

Announcements

Article on cross-jurisdictional sharing of public health lab services. Public Health Reports has published“Legal Considerations in Cross-Jurisdictional Sharing of Public Health Laboratory Services,” by Molly R. Berkery, J.D., M.P.H. and Matthew S. Penn, J.D., M.L.I.S., of CDC’s Public Health Law Program. The article summarizes some of the potentially relevant federal and state legal issues related to cross-jurisdictional sharing of public health laboratory testing services. The special Association of Public Health Laboratories/CDC supplement of Public Health Reports is devoted to public health laboratories systems, with an emphasis on activities and approaches that represent managing and improving the system across many different dimensions. Find more information and access the article, Public Health Rep. 2013 Sep; 128(Sppl): 70–74, and full electronic supplement.


Report on Legal Considerations in Electronic Laboratory Reporting. The Council of State and Territorial Epidemiologists (CSTE) and CDC have published “Legal Considerations in Electronic Laboratory Reporting: A report of the CSTE-CDC Electronic Laboratory Reporting Task Force Legal Considerations Workgroup,” by Frederic E. Shaw, M.D., J.D. and Molly R. Berkery, J.D., M.P.H. Find more information and access the report [PDF - 358KB].


Webinar on intimate partner violence as a public health issue. The Network for Public Health Law will present a webinar, “Intimate Partner Violence as Public Health Issue: The Violence Against Women Act and Other Legal Protections for Immigrant and LGBT Communities” on Thursday, October 17, 2013, from 1 to 2 pm (ET). The webinar will address the importance of viewing intimate partner violence as a public health issue and examine how the Act and other legal remedies are used to help vulnerable populations. The webinar will be archived. Find more information and register for the webinar.


Job opening for senior attorney with ChangeLab Solutions. ChangeLab Solutions is looking for a senior attorney with a strong background in public health practice to help their work on the new CDC-funded position to improve the capacity of the public health workforce related to public health law. This work will be developed in collaboration with the “Legal Organization Consortium,” which consists of ChangeLab Solutions, the Network for Public Health Law, the Public Health Law Center, and Public Health Law Research. The Legal Organization Consortium is partnered with and championed by the CDC Public Health Law Program. Lean more and apply for the position.


Faculty Fellowships in Public Health Law. Georgia State University College of Law and its Center for Law, Health & Society are leading an initiative funded by the Robert Wood Johnson Foundation for a faculty fellowship program to promote public health law education. Ten faculty members from law schools or schools/programs of public health will be selected to participate in a yearlong fellowship program designed to foster innovations in educational programming (including clinical, externship, and other experiential learning) and to build a strong learning community among faculty who teach in the public health law field. The application period is open from September 3 to December 13, 3013. Letters of reference are due by December 6, 2013. Find complete eligibility requirements, program information, and apply for the fellowship.


APHA’s 141st Annual Meeting and Exposition. The American Public Health Association (APHA) will host the 141th annual meeting an exposition November 2–6, 2013, in Boston, Massachusetts. Register before September 26 for advance registration prices. Stay connected before, during, and after the annual meeting through APHA’s social media lab. Find more information about APHA and register for the annual meeting.


Radiation and Public Health Legal Considerations. The National Alliance for Radiation Readiness (NARR) hosted a webinar on Wednesday, September 18, 2013, discussing the radiation legal preparedness project assessing state and local legal authorities related to the response to and recovery from a radiation incident. Learn more about radiation readiness and access the archived the webinar on the NARR clearinghouse.


Two new maps outlining state public health laws. Public Health Law Research published two new state law maps on child restraint laws (i.e., seat belts) and scope of practice laws for dental hygienists. The two new maps are the latest additions to an already existing library of state law maps on important public health issues, such as distracted driving, youth concussions, and sterile syringe access for drug users. The maps are based on comprehensive datasets outlining laws across all 50 states and the District of Columbia. Find more information and access the maps.


The Health Insurance Marketplace opens October 1, 2013. The Marketplace is a new way to find health coverage that fits individual budgets and needs. Those using the Marketplace will receive tailored information about health insurance premiums and coverage options. Find more information about the Health Insurance Marketplace.

Legal Tools

Health Legislative Resource Book. The Minnesota Department of Health (MDH) released the 2013 Legislative Resource Book, which summarizes relevant public health laws passed in the 2013 legislative term and how the laws pertain to the MDH. Short summaries of the legislation contained within the book will assist the public and public health professionals understand and navigate the new laws. Find more information and access the MDH’s 2013 Legislative Resource Book [PDF - 249KB].


Toolkit to inform constituents about the Health Insurance Marketplace. The Office for State, Tribal, Local and Territorial Support’s Program Planning and Communication Unit has released a communication toolkit to help health agencies educate and encourage constituents who need insurance coverage to enrollment in the Health Insurance Marketplace, which opens October 1, 2013. Find more information and access the toolkit.

Top Stories

National: Schools can administer insulin without licensed nurses, court says

Los Angeles Times   (09/10/2013)   Maura Dolan

On August 12, 2013, the California Supreme Court ruled unanimously that trained school employees may administer prescription medication injections, such as insulin, to students.

While about 14,000 California school children have diabetes and need regular insulin injections, the California school system has only one nurse for every 2,200 students. Twenty-six percent of California schools have no school nurse, 69 percent have part-time nurses, and a mere 5 percent have full-time nurses. “As a result, diabetic students have encountered difficulty in receiving insulin during the school day,” said the court.

The American Nurses Association, the plaintiff, maintains that the decision will put children at risk. “This decision lowers [the] level of care for children who are entitled to receive healthcare services at school and puts them at risk for medication errors that could have sever health consequences,” the association said.

Others, such as the Disability Rights Education and Defense Fund (DREDF), which represented the American Diabetes Association in the case, applaud the decision and support the broader implications it may have for people with disabilities. The “ability to access services such as administering medication through attendants or other caregivers is integral to living independently in the community or receiving affordable residential care elsewhere. The question of who can provide what type of service is crucial to the people who need those services,” said DREDF.

[Editor’s note: Find more information and read the Supreme Court of California’s August 12, 2013, opinion in American Nurses Association v. Torlakson [PDF - 318KB].]


National: To cut abuse, FDA is altering pain killer label rules

New York Times   (09/10/2013)   Sabrina Tavernise

On September 10, 2013, the U.S. Food and Drug Administration (FDA) announced new labeling requirements for long-acting prescription pain-killers. The new labeling requirements are the latest effort to stem the growing instances of prescription drug abuse in the United States.

The changes require modification of the language describing the drugs’ prescriptive uses. Currently, the labels indicate that long-acting pain killers, such as OxyContin and morphine, should be used for moderate to severe pain. Dr. Douglas Throckmorton, deputy director for regulatory programs at the FDA’s Center for Drug Evaluation and Research, said the current labels were unclear because “[w]hat is moderate to me could be severe to you.”

The new language will indicate that the drugs should be prescribed only for patients who do not have other treatment options, and should be used to manage pain that is “severe enough” to require round-the-clock treatment.

The new changes will also require drug producers to conduct studies on the long-term risks associated with taking such long-acting pain killers.

The changes, which the FDA hopes would “help improve the thoughtful prescribing of these medicines,” are set to take effect by the end of the year.

[Editor’s note: Find more information and read the FDA’s new safety measures for extended-release and long-acting opioids.]

Briefly Noted

California: Concerns over adult film condom law enforcement after HIV positive tests
Another U.S. porn actor tests positive for HIV, leading to moratorium
Reuters   (09/06/2013)   Alex Dobuzinskis


Massachusetts: E-cigarette loophole in town’s ban on underage tobacco use
E-Cigarettes dodge ban in Mass. Town’s underage smoking law
Boston Business Journal   (08/13/2013)   Galen Moore


Minnesota: Disaster relief allocated $4.5 million for storm damage
Legislators, governor approve disaster relief bill
Politics Minnesota   (09/09/2013)   Briana Bierschbach


New Jersey: Medical marijuana for kids with three doctors’ notes under new bill
N.J. lawmakers pass Christie changes to Pot-for-Tots bill
Bloomberg   (09/09/2013)   Terrence Dopp


South Dakota: Reservation legalizes alcohol, plans to use profit for alcohol treatment
South Dakota’s Pine Ridge Indian Reservation votes to legalize alcohol
NBC News   (08/15/2013)   Carson Walker


Texas: ‘Reason of conscience’ vaccine opt-outs, measles, and pertussis outbreaks
Is Texas a hotspot for outbreaks of vaccine-preventable diseases?
Forbes   (09/09/2013)   Emily Willingham


Vermont: State first to offer free breakfast and lunch to all  low-income students
Vermont first state to offer free breakfast and lunch to students
Stateline.org   (09/09/2013)   Adrienne Lu
[Editor’s note: Learn more about Vermont’s school meal programs.]


Washington, D.C.: Health department proposes 24-hour wait for tattoos, piercings
‘Think Before You Ink’ law may put a 24-hour waiting period on tattoos, piercings
ABC News   (09/08/2013)   Susan Saulny and Alexis Shaw


National: Eight years later, questions over wind or water damage rock in Katrina’s wake
Hurricane Katrina’s mark on coverage law felt 8 years later
Law360   (09/03/2013)   Bibeka Shrestha


National: Kaiser report shows Healthcare Marketplace premiums will be competitive
No rate shock? Obamacare premiums lower than expected
TPM   (09/05/2013)   Dylan Scott
[Editor’s note: Find more information and read the Kaiser Family Foundation’s report, “An Early Look at Premiums and Insurer Participation in Health Insurance Marketplaces, 2014,” by Cynthia Cox, Gary Claxton, Larry Levitt, and Hana Khosla.]

Feature Profile in Public Health Law

James M. Galloway, MD, Rear Admiral U.S. Public Health Service

Title: Director Office of the Associate Director for Policy, Office of Health System Collaboration, Centers for Disease Control and Prevention

Education: BS, Virginia Commonwealth University; M.D. Medical College of Virginia; Residency at the University of Vermont; Cardiovascular Fellowship, University of Arizona; continued training in Health Care Management, Harvard University


CDC Public Health Law News (PHLN): What sparked your interest in public health?

Galloway: In my early professional life as a cardiologist working with American Indians on the Hopi reservation in northern Arizona, I was moved by the high frequency of cardiac pacemaker battery failures, at times with disastrous consequences. Prompt evaluation among survivors revealed a lack of understanding by these non-English speaking patients about pacemaker battery life and the need for routine battery life checks following pacemaker placements by off-reservation specialists.

A reservation-wide review, registry development, Community Health Worker intervention and appropriate patient education likely saved a number of lives annually. This small intervention taught me a valuable lesson about a broader sense of responsibility as a clinician and the potential value of these activities. I soon found myself engaged in multiple activities around quality development, prevention, and community health at a broad level.

PHLN: Please describe your career path to becoming the director of the Office of Health Systems Collaboration at CDC.

Galloway: Following medical school and residency, I began my career as an internist on the Hopi Reservation, followed by roles as medical director of an Indian health hospital on the Whiteriver Reservation and subsequently the San Carlos Apache Reservation. Following some of the experiences I listed above, I felt I needed to become a cardiologist and develop a Native American cardiology program that would incorporate language, culture, and traditional values into cardiovascular care. I led the University of Arizona Center for Native American Health to assist tribes in their cardiovascular healthcare needs in the southwest and the nation. I subsequently was selected as the Regional Health and Human Services (HHS) health administrator and an Assistant US Surgeon General for the US Public Health Service, based in Chicago before starting here at CDC recently.

PHLN: Can you describe how your job intersects with law?

Galloway: In a sense, everything we all do at CDC intersects with law, because everything we do has to be authorized by law and supported by appropriations. Perhaps the biggest impact for our most recent activities is the Affordable Care Act (ACA), signed into law by President Obama in 2010. The provisions of that law direct a lot of what we do in my office, and in the Office of the Associate Director for Policy at CDC. We are working hard to strengthen public health and healthcare collaboration, and the ACA provides a unique opportunity to increase the value of the health investments we make by aligning, coordinating, and integrating public health and health care. There are many examples of this, but one is the law’s emphasis on prevention, and especially on clinical preventive services. My office works with partners inside and outside CDC to optimize the uptake of these services, which ultimately can save lives.

PHLN: How else is CDC’s work related to the ACA?

Galloway: The ACA represents the greatest change in American health policy since the enactment of Medicare and Medicaid in the mid-1960s. For example, according to the Congressional Budget Office, the law will is expected to expand health insurance coverage to 25 million more Americans by the end of 2016. We know having health insurance is associated with a greater sense of well-being, and, in some ways, improved health status and even a lower risk of mortality.

We also know that having health insurance leads to a greater use of some clinical preventive services, which, simply put, can save lives. Better uptake of clinical preventive services is a great concern of CDC. The law requires new private insurance and expanded Medicaid plans to cover key, proven clinical preventive services without cost-sharing, meaning no co-pay or deductible.
The ACA increases the emphasis in the American health system on prevention, through policies and programs and through increasing funding. For example, the law created the Prevention and Public Health Fund (“the Prevention Fund”) which provides sustainable funding to address the primary care workforce, community and clinical prevention, public health infrastructure, and public health data collection. It empowers communities to prevent the leading causes of death from heart attacks, cancer, and stroke to injuries and more. CDC administers many of the programs funded by the Prevention Fund.

The law also created the National Prevention, Health Promotion, and Public Health Council which provides an opportunity to prioritize and align prevention efforts across the federal government and the nation. The Council is chaired by the Surgeon General and has members from 20 federal departments and is supported by an advisory group with 22 non-federal appointed members. CDC staffs the Council and has been closely involved in the drafting of the nation’s first National Prevention Strategy, created by the Council.

The ACA also seeks to bridge the gap between health care and public health and build a stronger bond between the two. For example, the law empowers and funds the Centers for Medicare & Medicaid Services to innovate new models of delivering care around the nation. CDC has been closely involved with the design of these models and in tracking how they affect public health at the state and locals levels.

It would be very difficult to list all the ways that the law affects the work of CDC, but those are a few good examples.

PHLN: How have CDC’s mission and priorities transformed with the creation of the ACA?

Galloway: The ACA provides public health at all levels, local, state, and federal—including CDC—with a unique opportunity to make a bigger impact. Take, for example, clinical preventive services, a big concern for CDC’s mission of preventing disease. HHS has estimated that, because of the law, 71 million Americans with private health insurance and 34 million Medicare beneficiaries already have received expanded coverage of at least some preventive services without co-pays or deductibles. This includes vaccinations, blood pressure and cholesterol tests, mammograms, colonoscopies and screenings for osteoporosis. We know that prevention is still the best path toward healthier communities, and the law is taking us toward better emphasis on prevention in the American health system.

PHLN: How does the ACA relate to CDC’s Winnable Battles?

Galloway: Winnable Battles are public health priorities with large-scale impact on health and with known, effective strategies to address them. Six of the leading causes of deaths in the US, as of 2011, are amenable to prevention interventions that are addressed by some of the Winnable Battles, which include heart disease, cancer, chronic lower respiratory diseases, cerebrovascular diseases, unintentional injury, and diabetes.

As the number of Americans with health insurance coverage increases, more and more will be able to access preventive services with no co-pay or deductibles. Through programs funded by the ACACA, public health has stronger weapons to win these battles. For example, the law’s Prevention Fund supports programs such as the Community Transformation Grants, which empower local communities to use proven practices to improve nutrition and physical activity, reduce tobacco use, and control high blood pressure and high cholesterol. It funds “Tips from Former Smokers” (the first national anti-tobacco campaign), the Partnership for Patients (a public-private partnership established with the goals of reducing preventable hospital-acquired conditions), and the Million Hearts® initiative, created with the goal of preventing one million heart attacks and strokes by the year 2017.

PHLN: What is the Health Insurance Marketplace (Marketplace)?

Galloway: Beginning October 1, 2013, there will be a new way to shop for health insurance coverage under the ACA—the Health Insurance Marketplace. Families, individuals, and small businesses will be able to use the Marketplace to find comprehensive health coverage that fits their budgets and health needs. They’ll be able to compare health insurance plans based on costs, benefits, and quality. No matter where they live, consumers will only need to fill out a single application on the Marketplace to choose from the health plans available in their area, to learn if they qualify for programs like Medicaid or the Children’s Health Insurance Program, or to find out if they qualify for a free or low-cost plan, lower out-of-pocket costs, or a new kind of tax credit that immediately reduces monthly premiums.
Starting in 2014, all plans offered through the Marketplace must offer essential health benefits—including doctor’s visits, hospital stays, preventive services, prescription drugs, mental health, and other categories of coverage. Insurance plans will no longer be able to charge you more or refuse to provide coverage for you or your family if you have a pre-existing condition. Remember that only plans offered in the Marketplace offer lower costs based on income.

I recommend visiting http://www.healthcare.gov to get more information.

PHLN: How is the Marketplace related to CDC’s work and goals?

Galloway: The Congressional Budget Office has estimated that, through the Marketplace, an estimated 25 million Americans will acquire affordable health insurance by the end of 2016. As I mentioned earlier, acquisition of health insurance is associated with greater use of some clinical preventive services, certain improvements in health status, and may be associated with reductions in mortality. These are all integral to CDC’s goals of prevention.

PHLN: How is CDC working to support the Marketplace?

Galloway: CDC has been doing a lot to support the Marketplace. CDC has actively promoted the Health Insurance Marketplace as part of the HHS-wide initiative. CDC currently is working to increase awareness and understanding of enrollment and its close connection to clinical prevention services uptake and population health.

Here are some examples of specific activities: CDC has developed focused information for media interviews, conference presentations, and social media (e.g., blog posts, Twitter and Facebook). Internal to the agency we have distributed toolkits and other resources (including PowerPoint slides, talking points, web badge) to relevant CDC staff members for internal use and partner outreach. We have added language about the Marketplace to CDC Funding Opportunity Announcements, placed enrollment messaging on wait recordings for CDC-INFO, CDC’s direct contact “800” number, and provided direct support to conduct trainings via the healthcare.gov YouTube channel on enrollment.

PHLN: As a physician and a public health practitioner you have a unique perspective on public health; looking at the transformation of our health system, which changes have you found to be the most positive and what changes do you expect to see in the future?

Galloway: One of the most positive changes I’ve seen in recent years is the improved collaboration between public health and clinical care providers. At the federal level, CDC and CMS are working closely together to prevent heart attacks and strokes and reduce HAIs, for example. At the state and local level, public health and healthcare systems are at the table together. States and communities are taking a comprehensive approach to addressing issues such as prescription opiate overdoses, tobacco use and diabetes. Public health and healthcare collaboration provides big opportunity into the next decade and we are working together better than ever before and seeing progress in a number of areas. I expect in the future this will only improve, and as a result, we will see the health status of our nation improve.

PHLN: Are you working on any exciting projects you would like to share?

Galloway: I am very excited to be working with incredible, energetic, and very smart individuals at CDC and across the country who are dedicated to bringing the work of our healthcare and public health communities closer together for the improvement of the health of the communities and people of our nation.

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

Galloway: I am married to a really excellent cardiovascular nurse and we have four wonderful children, one who recently received her master of public health  working in Africa, one working in the support of women in South America, one just back from studying and learning about nutrition in Central America and one in Seattle, still in college.

PHLN: Have you read any good books lately?

Galloway: I very much enjoyed reading “Drive” by Daniel Pink recently, about the motivations that drive us as individuals.

Court Opinions

Texas: City’s clean air ordinance not preempted by state law
City of Houston v. BCCA Appeal Group, Inc.
Court of Appeals of Texas, First District, Houston
Case no. 01-11-00332-CV
Decided 08/29/2013
Opinion by Justice Jim Sharp


Federal: No permissive standing for intervenor in hospital patient arbitration case
Valley View Health Care, Inc. v. Chapman [PDF - 318KB]
United States District Court for the Eastern District of California
Case No. 1:13-cv-0036-LJO-BAM
Decided 08/27/2013
Order by Magistrate Judge Barbara A. McAuliffe


Federal: No “state-created-danger” in merger of two gang-associated schools
Walker v. Detroit Public School District [PDF - 79KB]
United States Court of Appeals for the Sixth Circuit
Case No. 12-1367
Filed 08/26/2013
Opinion by Judge Alan E. Norris


Federal: California Sexual Orientation Change Efforts Law does not impede free speech
Pickup v. Brown [PDF - 170KB]
United States Court of Appeals for the Ninth Circuit
Case Nos. 12-17681, 13-15023
Decided 08/29/2013
Opinion by Judge Susan P. Graber

Quotation of the Month

California Supreme Court Justice Kathryn Mickle Werdegar

“California law expressly permits trained, unlicensed school personnel to administer prescription medications such as insulin in accordance with the written statements of a student’s treating physician and parents,” wrote California Supreme Court Justice Kathryn Mickle Werdegar in American Nurses Association v. Torlakson, Supreme Court of California, Case Number S184585, August 12, 2013.  

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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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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