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February 2015—Public Health Law News

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In This Edition

Announcements—Judiciary and Public Health Webinar, Health System Transformation Webinar, NACCHO Annual Conference, More...

Webinar—When Public Health Goes to Court: Judicial Structure and Functions. The Public Health Law Program (PHLP) and the Network for Public Health Law are co-hosting a three-part webinar series on the judiciary’s role in public health. The second webinar in the series will take place Thursday, March 5, 2015, 1:00–2:30 pm (EST). This webinar will consider the role of case law in public health. Participants will hear summaries of recent cases related to the ACA and other board of health actions. Additionally, panelists will offer tips on how public health practitioners can help legal counsel prepare to litigate a public health case before a state, local, or administrative judge. The webinar is free, and CLEs are available for some attendees.

Webinar—Health System Transformation: The Changing Legal Landscape. PHLP and the American Bar Association Health Law Section are co-hosting a three-part webinar series focused on three components of health system transformation: social impact bonds, workplace wellness programs, and electronic health information. The first webinar in the series will take place Wednesday, March 18, 2015, 1:00–2:30 pm (EST) and will discuss the legal framework for social impact bonds.

American Public Health Association (APHA) Fellowship. The APHA Public Health Fellowship in Government is designed to provide a unique public policy learning experience, demonstrate the value of science-government interaction, and enhance public health science and practical knowledge in government. Applications are due March 9, 2015.

NACCHO Annual Conference 2015. The National Association of County and City Health Officials (NACCHO) Annual Conference will take place July 7–9 in Kansas City, Missouri. The conference theme is “Envisioning the Future: Creating Our Path.” Register on or before June 4, 2015, to take advantage of early bird rates.

Food Safety e-Learning Video. CDC’s Environmental Health Services Branch has released a video promoting CDC’s interactive e-Learning on Environmental Assessment of Food Borne Illness Outbreaks. The e-leaning course teaches critical skills environmental health staff need to participate in an outbreak investigation.

Legal Tools—Ebola & Legal Preparedness, Death Investigation Systems, AI/AN ACA Resources, More...

Ebola and the Law: Legal Preparedness for Physicians and Hospitals. [PDF 343KB] PHLP’s issue brief describes case law, statutes, and information about CDC guidance for healthcare and public health attorneys to address questions and concerns related to legal preparedness for potential infectious disease outbreaks.

State Ebola protocols. PHLP has updated the table of state-by-state Ebola protocols to help law and policy makers prepare for and respond to Ebola-related situations.

State death investigation systems resources. At the request of the National Center for Health Statistics, PHLP assessed coroner and medical examiner laws across the 50 states and the District of Columbia. These assessments provide information on death investigation systems, coroner training requirements, medicolegal offices, death investigation and autopsies, and more. These resources are useful to law and policy makers interested in how death investigation systems are structured and death investigators’ scope of practice.

American Indian and Alaska Native Communities ACA resources. [PDF -270KB] PHLP published The Affordable Care Act & American Indian and Alaska Native Communities: Selected Readings and Resources, a resource list of readings and resources that describe and discuss the Affordable Care Act and the Indian Health Care Improvement Act’s impact on American Indian and Alaska Native communities. The list includes summaries of the laws, scholarly articles, and resources on enrollment and exemptions.

Health Department Billing for Immunization Services: A Menu of Suggested Provisions. [PDF 434KB] This menu summarizes state law provisions that impact the health department’s authority to bill third parties for services provided. PHLP created the menu in cooperation with the National Center for Immunization and Respiratory Diseases.       

Top Stories—Measles, Marijuana Auto Crash Report

Measles outbreak: doctors see tighter ‘philosophical’ vaccine exemption as fix
The Guardian   (02/05/2015)   Lauren Gambino

From January 1 to February 6, 2015, people from 17 states and Washington DC were reported to have measles. Eighty-three percent of the cases are part of a multi-state outbreak linked to an amusement park in California. On February 4, 2015, California lawmakers announced their intention to propose a bill to ban parents from opting out of vaccines on philosophical grounds.

According to the National Conference of State Legislatures, 50 states require specific vaccines for school children. Most states allow religious exemptions for vaccines; 20 states allow philosophical exemptions for individuals who have non-religious, personal beliefs against vaccines.

A 2012 study published in Advanced Preventative Medicine, Parents' Source of Vaccine Information and Impact on Vaccine Attitudes, Beliefs, and Nonmedical Exemptions, showed that legation narrowing parents’ exemption options could help bring down the opt-out rates.

“What we showed was that there was an association between rates of exemptions and the ease of obtaining and exemption. The more difficult it is to obtain an exemption, the lower the rate of exemption, and the lower the rate of disease,” said Saad Omer, the study’s lead author, infectious disease epidemiologist and professor of epidemiology at Emory University.

Oregon passed a stricter vaccine exemption law that went into effect in March 2014. “The goal of the new non-medical exemption law is to make sure parents have a little bit of education about the benefits and risks of immunization prior to claiming a non-medical exemption,” said Stacy de Assis Matthews, school law coordinator for Oregon’s public health division.

Under Oregon’s new law, parents must visit a healthcare practitioner or participate in an online module about vaccines before they can exempt their children. “It’s a big change from in the past where parents just used to sign a form to claim an exemption,” said de Assis Matthews.

[Editor’s note: Learn more about the current measles outbreak and read Oregon’s immunization laws. Also, learn more about immunization and CDC’s recommended immunization schedule.]

US: Pot use doesn’t increase crash risk
The Detroit News   (02/07/2015)   David Shepardson

Recreational marijuana use is legal in Colorado and Oregon, and this year it will also become legal in Alaska and Washington. Given the newness of legal use, policy makers and scientists are still evaluating safety data. On February 6, 2015, the National Highway Traffic Safety Administration (NHTSA) released a report of drivers finding no evidence that marijuana use is associated with a significant increase in crash rates, unlike drinking and driving, which significantly raise the statistic likelihood of an automobile accident.

The report was based on two surveys and was conducted over a 20–month period in 2013 and 2014. The National Roadside Survey collected information from volunteer drivers at 300 research checkpoints across the US. The second survey, the largest of its kind ever conducted, collected data from more than 3,000 drivers who were in crashes and a comparison group of 6,000 drivers who had not crashed. 

Though, marijuana users were about 25 percent more likely to be involved in an accident than non-users. NHTSA said underlying factors, such as gender and age, appear to account more fully for the increased crash risk.

Former Acting NHTSA Administrator David Kelly cautioned that the study results should not be interpreted as an assertion that driving under the influence of marijuana is safe; further research is needed “before more definitive conclusions about drug use and crash risk can be reached. . . You can’t say that driving while stoned is not a risk. We know it debilitates the ability to drive safely,” said Kelly.

“Nobody should drive while impaired by any substance, and that’s why there are laws on the books to address it. While the research is pretty clear that marijuana use is not remotely problematic as alcohol when it comes to driving, it can cause impairment,” said Mason Tvert, director of communications for the Marijuana Policy Project in Denver, Colorado.

[Editor’s note: Read NHTSA’s study on impaired driving and Colorado’s first bi-annual marijuana monitoring report, Monitoring Health Concerns Related to Marijuana in Colorado: 2014 [PDF 4.37MB].]

Briefly Noted—Texas Ebola Response Law, Civil Rights and Traffic Violations, HPV Vaccine, More...

Missouri: civil rights suit alleges jail sentences for inability to pay traffic fines 
Civil rights attorneys sue Ferguson over ‘debtors prisons’
National Public Radio   (02/08/2015)   Joseph Shapiro
[Editor’s note: Read the Saint Louis University School of Law’s press release about the lawsuit [PDF 1.37KB].]

New York: NYC to add 45 ambulances and hire 149 more emergency dispatchers
De Blasio aims to improve medical response times
New York Times   (02/08/2015)  

Puerto Rico: Bill proposed fining parents of obese children
Puerto Rico considers fining parents of obese children
The Washington Post   (02/10/2015)  

Texas: Proposed law would create infectious disease stockpile and more
After Ebola scare, Texas bill seeks to fix outbreak response
Emergency Management   (02/12/2015)   Ryan McCrimmon
[Editor’s note: Read Texas’ Senate Bill 538.]

Utah: Maternal/child health, homelessness considered for Pay for Success
County exploring 3 more ‘pay for success’ issues
The Salt Lake Tribune   (01/15/2015)   Mike Gorrell

National: Decline in cancer rates related to declines in tobacco use and more
Cancer rates down 22 percent in US over 20 years   (02/08/2015)   Diane Smith
[Editor’s note: Read the Family Smoking Prevention and Tobacco Control Act and read the joint letter to HHS Secretary Burwell from national public health partners opposing changes to the grandfather date of the Family Smoking Prevention and Tobacco Control Act.]

National: Drug abuse education redesigned in face of prescription drug epidemic
NOPE. Teen drug war morphs to shock and education
NewsLedge   (02/09/2015)   Marchs Chavers
[Editor’s note: Learn more about prescription drug abuse, prescription drug abuse laws and the Narcotics Overdose Prevention and Education NOPE Taskforce.]

National: School policies could address vaccine exemption law and policy questions
Schools may solve the anti-vaccine parenting deadlock
Government Executive   (02/05/2015)   Jacoba Urist

National: Vaccine unlikely to encourage more sexual activity in girls 12–18
Study: HPV vaccines do not lead teen girls to risky sex
USA Today   (02/09/2015)   Kim Painter
[Editor’s note: Read Incidence of Sexually Transmitted Infections After Human Papillomavirus Vaccination Among Adolescent Females. Jena AB, Goldman DP, Seabury SA. JAMA Intern. Med. published online Feb. 9, 2015. doi:10.1001/jamainternmed.2014.7886.]

National: Second largest health insurer hacked, personal data compromised
Victims of Social Security number theft find it’s hard to bounce back
National Public Radio   (02/09/2015)   Brian Naylor

Feature Profile in Public Health Law—Maria Hernandez, President and Chief Operation Officer, Impact4Health

President and Chief Operation Officer, Impact4Health, LLC

PhD in community psychology from the University of Texas

PHLN: Please describe your career path.

Hernandez: My career path is not very traditional and a good example of how even the best made plans lead us to uncharted territory. I fully intended on an academic career path after graduating from the University of Texas. Unfortunately, I found that being a 27-year-old Latina with a PhD in 1985 was a real challenge. Many women don’t hear the thud of hitting the glass ceiling. I did, so I left my academic career in 1994 and began consulting to a wide range public, corporate, and nonprofit organizations, leveraging my multidisciplinary background to facilitate organizational change initiatives, professional development programs, and capacity building. While I had consulted in a large nonprofit hospital system for several years, my formal entry into population health came when a colleague asked me to work with Dr. Len Syme. Len is largely considered the father of social epidemiology, and he asked me to support his work with Cigna’s Communities of Health Initiative in Las Vegas in 2008. Once that was completed, we kept our conversations going. It was about that time that I sold my consulting firm in 2010 and began working with InclusionINC shortly thereafter. My continued conversations with Len lead me to start working on Pay for Success Initiatives with the California Endowment. About a year ago, I convinced InclusionINC’s CEO to create a division specifically focused on addressing healthcare outcome disparities and population health. In many ways, I feel my education and myriad of experiences in different sectors—from nonprofits in affordable housing to public utilities to high tech to banking—was perfect preparation for the work I address in population health.

PHLN: What is Impact4Health?

Hernandez: We are a multidisciplinary team comprised of psychologists, public health researchers, impact investment advisors, and physicians. We are focused on addressing healthcare outcome inequities, supporting innovative programs that address upstream social determinants of health and preparing healthcare teams to work collaboratively in diverse teams serving diverse patients. Our work involves facilitating capacity building efforts, designing and delivering training, and bridging population health efforts between public health and healthcare systems.

PHLN: Please describe your day-to-day job responsibilities as the president and chief operating officer of Impact4Health.

Hernandez: I start my day at 5:30 am in order to keep up with colleagues and projects on the East Coast! Pretty much my day is centered on three activities: managing existing projects, marketing our work, and keeping abreast of the tsunami of issues hitting the healthcare industry now. Healthcare reform is just one of the many factors influencing how the industry serves vulnerable populations. The entire sector is in the middle of a fundamental shift in the way the profession views itself—from the right way to organize patient-centered care to the best processes and protocols that will insure staff deliver the highest quality of care to how best to use “big data” for mapping population health. In 20 years or so, we will be asking ourselves why we did things  this way for so long.

PHLN: Do you perceive yourself as working in public health law?

Hernandez: The Pay for Success field is barely four years old, and I fully expect that there will need to be policy changes to allow public dollars to pay back investors for fully investing in key interventions that end up saving tax payer dollars. There is a healthy debate in some parts of the country on whether this will require changes to local statutes or state law because it will be problematic to pay out dollars to investors. This is why I’ve made the case that Community Foundations [PDF 445KB] need to step in and be financial intermediaries. While I am not currently involved in any task force addressing those policy changes, I expect that all of us working in this nascent field will be looking at how existing public health law will need to catch up with this model of financing interventions.

PHLN: What are “pay for success” (PFS) or “pay for performance” initiatives?

Hernandez: In short, PFS initiatives are detailed contracts among impact investors, intervention program providers, and the end payors who must all agree on target outcomes (successes) linked to a return on investment. A PFS reduces the cost of addressing a chronic social issue for some interested party—a public agency or private entity. A PFS should be thought of as an elegant theory or model that can be interpreted differently in each initiative, however. In several existing initiatives in the United States, the end payor is a public entity who pays investors based on the savings the initiative generates. For example, in New York, it is the City of New York that will pay back the investors if recidivism is reduced among inmates released from Riker’s Island Correctional Facility based on the savings they will garner if fewer inmates need to be housed. The program intervention in New York is provided by Manpower Demonstration Research Corporation (MDRC), a nonprofit with a history of successful ex-inmate rehabilitation. In Alameda County, California’s PFS on asthma, the County Department of Public Health is going to pay for and provide the intervention. The end payors for the project will include health insurance carriers and hospitals charitable care funds that save in treatment costs.

PHLN: What are social impact bonds (SIB) and how are they different from other pay for success initiatives?

Hernandez: The term “social impact bond” was first used in the United Kingdom for the first ever SIB focused on recidivism. I know of only one initiative in Richmond, California where a true municipal bond has been issued to buy and rehabilitate bank owned homes. The Richmond Community Foundation will use the sale of those homes to pay back the bond and continue sustaining this effort to reduce blight and create workforce development opportunities. The White House Office of Social Innovation and Civic Engagement might have been the first to use PFS here in the United States because it specifically wanted to set the expectation that these are highly structured agreements and typically true municipal bonds.

PHLN: How can PFS potentially benefit governments?

Hernandez: In a perfect world, PFS initiatives will bring a new level of rigor to social intervention efforts across the country and create long term, sustainable funding for successful programs. Local, state, and federal agencies should be interested in seeing effective interventions achieve intended goals. Throughout the nation, there are many agency programs, nonprofits and faith-based organizations that are addressing chronic social conditions with enormous success. Unfortunately, they often have to struggle to find grants or foundation support year to year. It is an exhaustive effort, and as funding priorities change, some of these programs can suffer unexpected challenges to keep serving key populations. Clearly, if these programs can validate the benefits they provide to a community and specifically that they are saving tax payer dollars or keeping treatment costs well below what a hospital spends on care, these programs will ultimately save resources and attract impact investors. PFS initiatives should be embraced by local, state, and federal government leaders. This isn’t about reducing the role of government in social support systems across the country—as some in the blogosphere have argued—this is about government being effective at achieving outcomes that matter to us all.

PHLN: Why might private investors be interested in PFS?

Hernandez: PFS should attract private investors who want to make long-term, sustainable impact on the issues they find compelling—reducing chronic disease, curtailing homelessness, or revitalizing a neighborhood. They will see their investment not only produce a return, but potentially create a self-sustaining program that can serve more people or expand to other regions. They will know that their investment has been managed carefully to achieve key outcomes.

PHLN: How did you become interested in PFS?                         

Hernandez:I’ve always been an advocate of primary prevention—who can argue against preventing people from getting ill, being homeless, or losing their jobs? My conversations with Len helped to refine my thinking that there are known social determinants of health. When we started working together, he had just been featured in a PBS series called Unnatural Causes. It’s a great starting point for anyone interested understanding the current focus on “upstream” health interventions. We know what makes people ill—that there is this connection between your status, wealth, and your level of control in your daily life. We had some fascinating discussions about how to create an incentive to invest in health. Once of those conversations was with David Erickson at the San Francisco Federal Reserve, and it was David who shared a small article with us on social impact bonds. That began the spark in our thinking—along with Rick Brush, who at the time was an executive with Cigna’s Communities of Health “Let’s use this to address upstream health interventions.”

PHLN: How is law related to PFS?

Hernandez: I believe that the detailed contracts that some PFS initiatives create, like the one in Massachusetts [PDF 8.44MB], require significant legal expertise to structure. Because PFS is so new, I believe the kind of structure to these agreements will change as practitioners gain more expertise with what PFS agreements will require. Keep in mind that these agreements often require more than a year to formulate and certainly require a legally binding agreement to clarify the payment agreements..  In addition there is legislation called H.R. 4885 Social Impact Bond Act sponsored by Todd Young (R-IN9) and John Delaney (D-MD6) that is setting the stage for a stronger foundation in which the federal government might set specific outcomes for addressing key social conditions and then have states or municipal governments create proposals for addressing target goals. This legislation would pave the way for private sector to pay for programs and then use some of the tax payer dollars saved to pay back investors. I think this is a key development for PFS so that public dollars can be used for success payments across the country.

PHLN: You are a pioneer in the area of pay for performance models, and in 2011, you received a grant from the California Endowment [PDF 646KB] to co-author a study using SIBs to address chronic health conditions. Much of this study is tied to Fresno County, California’s SIB aimed at reducing asthma-related emergencies. Can you describe the program?

Hernandez: Actually, this study lead to two initiatives focused on reducing asthma-related hospitalizations and emergencies—one in Fresno and one Alameda County. Both projects are demonstration projects at this point because the overall effectiveness of the interventions needs to be validated. These projects must first address whether they are able to produce healthcare cost savings or not. In both projects, the end payors were always thought to be health insurance carriers, accountable care organizations or self-insured employers. In order to demonstrate those savings exist, it is necessary to run the program for one year to assess if the treatment works as intended. The California Endowment funded the entire intervention in Fresno. In Alameda County, the Department of Public Health funds the intervention with support for technical assistance from the US Department of Housing and Urban Development and the California Healthcare Foundation.

PHLN: What is the status of these projects?

Hernandez: Both projects are in a demonstration phase. In Fresno, the project continues to track the intervention’s impact on program participants, and the project actuary is looking at claims data to validate that the intervention will garner savings. This project’s intermediary is Social Finance [PDF 33KB]. I’m directly involved now in the day-to-day planning for Alameda County’s PFS, and we have just completed the design of the intervention—bringing together two different departments in the County: Healthy Homes and Asthma START—to formalize a working relationship into a formalized program. In Alameda County, we know that the average cost of a pediatric hospitalization is $16,545 and that our program costs (including staffing and administration) are set to $3,432. That’s a huge difference, so it would be easy to claim our return on investment (ROI) could be as much as 4.85—for every dollar spent on the intervention we will save 4.85 in healthcare costs. The challenge for us is that the cost of hospitalization and emergency department visits is based on averages of charges, not real costs. Our demonstration project requires a more in depth analysis of true savings with the collaboration of regional hospitals and insurance carriers covering our participants.

PHLN: What challenges did you face with these two efforts?

Hernandez: The first challenge is that this effort represents a new way of thinking about paying for social interventions and communities need time to understand what PFS really means. In Fresno, this was truly the first time a community was exposed to the idea of a SIB or PFS initiative, and I know that much of our early conversations were about explaining the model and how it could work. At that point in time if you Googled the term “social impact bond” there was literally only about 100 citations! Today you will get 139,000 results. The next hurdle was getting funding to pilot the program—that took close to a year after Rick Brush, CEO of Collective Health, Len Syme, and I completed the white paper. The third challenge common to both projects is to identify the true cost savings associated with the intervention. Hospital charges are not the same as hospital costs. I know that the true cost of care and the variance of costs from one hospital to another is the source of much debate and this has impacted this work as well.

PHLN: Are SIBs more applicable to specific kinds of health issues? If so, what kind of public health issues do you think SIBs could appropriately address?

Hernandez:This is something I get asked all the time. We chose to work on asthma first because there already exists strong evidence that if you reduce known asthma triggers—dust, pet dander, mold, rat or cockroach droppings—and provide a health management plan with health education, you can improve the quality of life for asthma patients and reduce asthma attacks in a relatively short period of time.

We were asked to look at diabetes quite a bit in our early conversations in Fresno. There are a lot of communities with significant rates of diabetes. While I think this is the next opportunity for a PFS, it is fair to say that this disease potentially has a much longer time frame for interventions. I know that CDC has partnered with the YMCA on a program that has created impressive early results showing they can keep a pre-diabetic adult from developing full blown diabetes. I’d love to work on a PFS on diabetes soon!

PHLN: What factors should jurisdictions take into account when considering SIB initiative implementation?

Hernandez:First and foremost, realize that each PFS initiative can be designed and structured differently. In order to put one together, you will need a range of subject matter experts coming together with expertise in a social condition or issue (e.g., affordable housing, public health, prisoner rehabilitation, homelessness) and those who will be able to identify the right financial model for your PFS that will appeal to investors and end payors. I think this is one of the most interesting aspects of PFS—this is truly a multidisciplinary effort that will require public health experts, financial analysts, program specialists, and evaluators all working together for collective impact. PFS has drawn together organizations as diverse as McKinsey, Harvard University, and Goldman Sachs. It has given birth to other organizations like Social Finance—US, Third Sector Capital Partners, and Instiglio. Communities should be careful to not to get caught up in some of the hype and hubris that is simply part of any new movement. My recommendation is to build internal capacity to understand what PFS can or cannot do for your region and proceed cautiously.

PHLN: What kind of planning is involved with implementing a SIB initiative?

Hernandez:This work is not for the faint of heart! There is a need to think of PFS in several stages that most likely will take over a year to implement. The first phase is all about the feasibility of the intervention—is there a program with existing data that validates key outcomes are being achieved? Are there sufficient savings to create a return on investment? Is it clear that the program is generating savings for key entities—public or private? Depending on your answers here you may need to run a demonstration project to validate that you have a viable intervention with a real ROI. The next phase will require assembling the key players—investors, project leaders, independent evaluators, and an intermediary that will provide technical support and oversight to the process. At this phase you will create the PFS Agreement or Memorandum of Understanding that details the specific agreed upon outcomes the program will achieve, how these will be measured and at what cost. Only after these phases are completed would the PFS actually begin.

PHLN: Who can invest in SIBs?

Hernandez: Most of the existing interventions are funded now by foundations. I anticipate that this will remain the case for a few more years and then we will see potentially institutional investors.

PHLN: Can private individuals also invest in SIBs?

Hernandez: Yes, a high net worth individual or a family foundation can invest, but it should be clear that to date all PFS are structured so that the investors are bearing the full risk of not receiving any payment at all. If the projects do not achieve their intended results, the investors receive nothing.

PHLN: How can policy makers and individuals learn more about SIB?

Hernandez: The Social Innovation Fund of the Corporation for National and Community Service has funded several organizations across the country to support the dissemination of PFS initiatives. Corporation for Supportive Housing, Third Sector Capital Partners, the Harvard Kennedy School Social Impact Bond Lab, National Council on Crime and Delinquency, the Nonprofit Finance Fund, and the University of Utah Policy Innovation Lab are all key sites to review. I would also encourage everyone to read the San Francisco Federal Reserve Bank’s Community Development Investment Review, Pay for Success Financing—Volume 9, Issue 1.

PHLN: Are you designing other PFS programs? If so, will you please describe them?

Hernandez:I am not involved in organizing a specific program now, but I am helping other communities put together exploratory committees together so that they can start their process. One of those communities is the Inland Empire which is composed of both San Bernardino and Riverside County. They hosted their first PFS stakeholder engagement effort in early February. We have the benefit of far more knowledge about PFS already in existence and far more interested stakeholders. They are considering several activities and looking forward to move on a PFS initiative within the year.

PHLN: If you weren’t working in the area of social finance and public health policy, what would you likely be doing?

Hernandez: I’m fortunate to still have opportunities to consult across all sectors and in a wide range of industries because I maintain a leadership role at InclusionINC, and I serve on the Board of Trustees at Alameda Healthy System. I truly enjoy work that requires a multidisciplinary approach to address complex issues. And, I like projects that start and finish in a reasonable time frame! As much as I felt a sense of loss leaving my academic position 20 years ago, I think this blend of consulting, research, and writing has been ever so satisfying.

PHLN: Have you read any good books lately?

Hernandez: I’ve got 124 books on my tablet, but the three I keep reading the most these days are Steven Brill’s America’s Bitter Pill, Adam Reich’s Selling Our Souls: The Commodification of Hospital Care in the US, and John Wennberg’s Tracking Medicine: A Researcher’s Quest to Understand Healthcare.

PHLN: What are your hobbies?

Hernandez: I probably am ever so fortunate to do what I love, so my hobbies are mostly about creating opportunities to get away and think—my husband and I are about to sail around the British Virgin Islands for the first time later this month, so we are both learning how to navigate new waters. It’s a great metaphor for our work and our lives.

PHLN: Is there anything you would like to add?

Hernandez: Thank you so much for this wonderful opportunity to share about my journey. I look forward to connecting with your readers who want to ask further questions. I’m active on social media, so please follow me on Twitter at @drmhernandez or join our email list at

[Editor’s note: Dr. Hernandez is one of the featured presenters in a webinar co-hosted by the American Bar Association and the Public Health Law Program. The webinar, The Legal Framework for Social Impact Bonds, will take place on Wednesday, March 18, 2015, from 1:00 to 2:30 pm (EDT), and is the first in a three-part series, Health System Transformation: The Changing Legal Landscape. Register for the free webinar . Read More about SIB on PHLP’s website. ]

Public Health Law News Quiz February 2015

The first reader to correctly answer the quiz question will be given a mini public health law profile in the March 2015 edition of the News. Entries should be emailed to with “PHL Quiz” as the subject heading. Entries without the heading will not be considered. Good luck!

Public Health Law News Quiz Question: February 2015

What is the date of the webinar that will feature Dr. Maria Hernandez and will be co-hosted by the American Bar Association and the Public Health Law Program?

Public Health Law News Quiz Question January 2015 Winner!

Tracy Joos

January Question:What kind of poem did Dr. Randy Hanzlick write for the January 2015 edition of the Public Health Law News?

Winning response: 
Dr. Hanzlick wrote a limerick for public health law.

Employment organization and job title:  Peoria City County Health Department in Peoria Illinois: Public Health RN

A brief explanation of your job:  I work in the Health Protection Division. I do infectious disease investigations, immunizations, and I work to protect the community against spread of disease and its consequences for the community as a whole.

Education: Diploma Graduate from Order of St. Francis Medical Center School of Nursing in 1987. I worked as a registered nurse at OSF St Francis Medical Center in Peoria, Illinois, until 2004 and have been a public health nurse for past 11 years.

Favorite section of the News: Any articles relating to the law and infectious disease. 

Why are you interested in public health law? The dynamic and balance between individual health choices and how it relates to the public has always interested me. The most recent case of the measles outbreak at Walt Disney Land in California is an example of how a choice to not vaccinate can affect an entire community. The future implications of this choice must be examined by public health. The laws put in place to protect the community must be balanced between the protection of the entire community and the individual’s personal health and lifestyle choice. Public health law is an entity that, at its best, works quietly to protect the community. The chance to protect, educate, do surveillance, and plan would not be possible without public health laws and the public health workforce. I am proud to say I am a public health nurse. I am here to protect, educate, and improve the health of my community.

Do you have any hobbies? I enjoy all aspects of music, entertainment, and just having fun with my family and friends. I play piano and sing professionally when I am not wearing my public health nurse cap. Being in the community, entertaining my family, friends and fellow music lovers has been my hobby for the past 20 years. 

Thank you for this opportunity, and most importantly, thank you for the ongoing and continued education regarding best practices and public health law!

Honorable Mention for the January 2015 Public Health Law News Quiz

Lisa A. Lang

Title: Assistant Director for Health Services Research Information
Head, National Information Center on Health Services Research and Health Care Technology, National Library of Medicine, National Institutes of Health

Ms. Lang’s Public Health law Haiku
Public need to know:
Forensic Pathology.
Deaths demystified.

Court Opinions—Paint Recycling, Lead Paint Housing Advertisement, Manure Dumping, More...

California: Recycling department had authority to implement pain recovery program
PaintCARE v. Mortensen
Court of Appeals of California, Second District, Division Seven
Case No. B25131
Filed 02/03/2015
Opinion by Judge Gail R. Feuer

Massachusetts: Ad regarding lead paint violated fair housing law, but no harm
Commonwealth v. Keramaris
Appeals Court of Massachusetts
Case No. 13-P-1473
Filed 02/02/2015
Opinion by the Court, Justice Janis M. Berry, Justice Sydney Hanlon, and Justice Judd J. Carhart

Federal: Contamination risk outweighs argument for stay in manure dumping case
Community Association for Restoration of Environment, Inc. v. Cow Palace, LLC
United States District Court, Eastern District of Washington
Case No. 2:13-CV03016-TOR
Filed 1/28/2915
Opinion by District Judge Thomas O. Rice                   

Federal: Violations of coal mining permits, adverse impact on stream ecosystem
Ohio Valley Environmental Coalition, Inc. v. Fola Coal Co., LLC
United States District Court, Southern District of West Virginia, Charleston Division
Civil Action No. 2:13-5006
Filed 01/27/2015
Opinion by District Judge Rover C. Chambers

Quotation of the Month—Saad Omer, Infectious Disease Epidemiologist

Quotation of the Month: Saad Omer, Infectious Disease Epidemiologist

“What we showed was that there was an association between rates of exemptions and the ease of obtaining and exemption. The more difficult it is to obtain an exemption, the lower the rate of exemption, and the lower the rate of disease,” said infectious disease epidemiologist, Saad Omer, of the relationship between vaccine exemption laws and exemption rates.   

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