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September 2014—Public Health Law News

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Emergency preparedness and equipment Public Health Law Program
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In This Edition

Announcements

Health system transformation webinars. CDC’s Public Health Law Program (PHLP) and the American Health Lawyers Association are co-hosting a three-part series of webinar roundtable discussions that will provide lawyers, in-house counsel, and academics an overview of health system transformation. The series will discuss PHLP’s research on law and policy related to health system transformation, accountable care organizations, and hospital presumptive eligibility for Medicaid. PHLP reserved 200 free registration spaces. Please register as soon as possible to ensure free registration. The next webinar will take place Monday, September 22, 2014, from 2:00 to 3:30 pm (EDT)


ACA litigation and implementation webinar. The Network for Public Health Law is hosting a webinar, ”Affordable Care Act: Litigation and Implementation Update,” on Thursday, October 16, 2014, from 3:00 to 4:15 pm (EDT). This webinar will provide an update on Affordable Care Act (ACA) implementation, including states’ decisions regarding Medicaid expansion and health insurance exchanges, as well as a number of provisions regarding public health. Experts will also discuss the legal challenges, some seeking to enjoin the law and others to enforce it. This webinar will be a special, live webcast of a session from the 2014 Public Health Law Conference.


CDC Public Health Law Program internships and externships. These internships and externships consist of 9–14 weeks of professional work experience, for academic credit, with PHLP in Atlanta, Georgia. The program features rolling start and completion dates throughout the academic year. It exposes law students to the public health field, allowing for exploration of the critical role law plays in advancing public health goals. The unpaid internships and externships are open to rising-third year and third year law students who are interested in exploring careers in public health law. Externs must receive academic credit. Spring 2015 applications must be submitted by November 1, 2014.


Tribal code-writing clinic. William Mitchell College of Law provides free code-writing and revision services for tribal nations. Students in the clinic work in teams of two or three under the supervision of a full-time Indian law professor to respond to specific requests pertaining to tribal codes (statutes), regulations, court rules, and other documents. Each project is custom-designed for the needs of the tribal nation. The clinic has a special emphasis on criminal law, but welcomes projects on any subject area. For more information about the Tribal Development Clinic, contact Professor Sarah Deer at sarah.deer@wmitchell.edu.


2014 Public Health Law Conference. The 2014 Public Health Law Conference will take place October 16–17, 2014, in Atlanta, Georgia. The conference will gather public health and legal experts from across the country to examine and discuss today’s critical challenges in public health law. An early-bird registration rate is available.


2014 APHA Meeting. The American Public Health Association’s (APHA) 142nd Annual Meeting, themed “Healthography: How Where You Live Affects Your Health and Well-Being,” will take place in New Orleans, November 15–19, 2014, at the Ernest N. Morial Convention Center. The advanced registration deadline is October 3, 2014. Registration fees increase after October 3.  

Legal Tools


Model Aquatic Health Code. CDC’s Model Aquatic Health Code (MAHC) is voluntary guidance based on science and best practices that can help state and local authorities make swimming and other water activities healthier and safer. States and localities can use the MAHC to create or update existing pool codes to reduce risk for outbreaks, drowning, and pool-chemical injuries. The MAHC guidelines address the design, construction, operation, maintenance, policies, and management of public aquatic facilities.


New HIV/AIDS legal tools and resources web page. CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention recently published a webpage related to public health laws. This web page includes various legal tools and resources that can help public health practitioners understand laws and regulations that might be facilitators or barriers to HIV, STD, and TB program effectiveness.   

Health System Transformation Resources

Hospital presumptive eligibility resources. Hospital presumptive eligibility (hospital PE) is a policy option that allows hospitals to provide temporary Medicaid coverage to individuals likely to qualify for Medicaid. Effective January 2014, the Affordable Care Act expanded the scope of the policy to allow hospitals to make presumptive eligibility determinations in every state for all Medicaid-eligible populations. These resources summarize Medicaid hospital PE programs and can help public health practitioners and attorneys practicing in a hospital setting understand state hospital PE implementation options and how hospitals can expand presumptive eligibility to new populations.


Social Impact Bonds Issue Brief. [PDF 301KB] Following a wave of states turning to social impact bonds (SIBs) to help finance innovative public health initiatives, a bill recently introduced in the US House of Representatives, with bipartisan support, would authorize greater federal participation in states’ efforts to use SIBs to promote public health. As part of PHLP’s ongoing efforts to monitor the development and use of these innovative public health financing tools, PHLP created this issue brief to outline key provisions and authorities of the Social Impact Bond Act (HR 4885).

Top Stories

National: CDC’s new pool guidelines could change your next pool visit
KSHB   (09/01/2014)   Amy Hawley

CDC released the first national Model Aquatic Health Code (MAHC) on August 29, 2014. The guidelines are recommended for adoption by local health departments to increase swimmer safety.

Over the past decades, pool-related health outbreaks have increased significantly. The new model rules provide tips on how to improve aquatic safety in a variety of aspects, including design and construction, water filtration, ventilation and air quality, and staff training.

Jurisdictions that adopt the MAHC may begin enforcing new standards such as showering before pool use, appropriate swim wear and disposal of diapers, and increased chemical level testing.

Professionals in the aquatics industry hope the MAHC will increase public awareness of safe practices and hygiene for pool use. “Realize if changing a child’s diaper on the side of the pool we come by and rinse that off, and it goes into the pool. Just being aware of that,” said Renee Reiss, the aquatic supervisor of Overland Park, Kansas.

The MAHC is the result of a decade of research and coordination between CDC and countless aquatics professionals, and includes feedback from several rounds of public comments.

[Editor’s Note: Find more information about the MAHC and how the new pool guidelines can help improve public health.]


National: Justice expands prescription drug return program
USA Today   (09/08/2014)   Kevin Johnson

Under an expanded prescription drug program, hospitals, pharmacies, and other authorized entities are allowed to accept excess drugs, including opioid pain relievers. The expansion, which was announced by Attorney General Eric Holder, on September 8, 2014, is the latest effort to curb prescription opioid abuse.

“Prescription drug misuse and abuse is an urgent and growing threat to our nation and its citizens . . . . As recently as 2011, more than half of the 41,300 unintentional drug overdose deaths in the United States involved prescription drugs—and opioid pain relievers were involved in nearly 17,000 of those deaths,” said Holder.

The policy represents the final rule for the Secure and Responsible Drug Disposal Act of 2010 and is an extension of a drug “take back” program implemented by the United States Drug Enforcement Administration.

Take back programs offer individuals safer ways of disposing of unused prescription drugs. Before the programs were offered, individuals often flushed excess drugs down the toilet or threw them in the garbage, methods which can pose environmental risks and hazards to children who could find drugs in the trash.

The extended program is expected to take effect October 9, 2014.

[Editor’s note: Find more information and learn more about the new Drug Take Back Effort.]

Briefly Noted

Georgia: State agencies forbidden from providing information about ACA
UGA Healthcare Navigators program ends, but Athens still an information source
Online Athens   (08/15/2014)   Lee Shearer
[Editor’s note: Read Georgia Code § 31-1-40 [PDF 19KB].]


New York: Law makers hope to extend 9/11 benefits an additional 25 years
N.Y. politicians to announce Zadroga 9/11 health law extension
NJ.com   (09/08/2014)   Alex Napoliello
[Editor’s note: Find more information and read the James Zadroga 9/11 Health and Compensation Act.]


New York: Female-driver-only taxis might violate state and federal discrimination laws
New car service app for women raises legal questions, experts say
Wall Street Journal   (09/08/2014)   Jacob Gershman


Oregon: Psychiatric boarding ban begins December 26, 2014
High court grants stay on psychiatric boarding ban
The Sacramento Bee   (09/05/2014)   Martha Bellisle


Washington: Recreational marijuana law created with frame work to study effects
How legalized marijuana is also a long-term ‘knowledge experiment’ in Washington state
Government Executive   (08/26/2014)   Michael Grass
[Editor’s note: Find more information about Washington’s marijuana laws.]


National: ‘Safe Harbor’ exception to anti-kickback law under scrutiny
A fast-growing medical lab tests anti-kickback law
Wall Street Journal   (09/08/2014)   John Carreyrou


National: Focusing on benefits to child could increase child vaccination rates
Doctors ID new ways to get more kids vaccinated
U.S. News and World Report   (08/19/2014)   Dennis Thompson
[Editor’s note: Find more information about CDC’s recommended childhood immunization schedules and vaccine requirements and laws.]


National: Fewer uninsured patients in states with Medicaid expansion
Expanding profits: Medicaid ‘expansion’ boom for hospitals
CNBC   (09/03/2014)   Dan Mangan
[Editor’s note: Find more information and read Medicaid 2.0, Health system haves and have nots [PDF 247KB], published by PricewaterhouseCoopers’ Health Research Institute.]


National: Study finds lower opiate related deaths after medical marijuana legalized
Medical marijuana could reduce painkiller abuse, study suggests
Los Angeles Times   (08/25/2014)   Melissa Healy
[Editor’s note: Read Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010, published online in JAMA Internal Medicine, August 25, 2014.]


National: Amended executive order for ‘acute respiratory syndromes’
President Obama allows quarantine of people with sever acute respiratory syndromes symptomatic of Ebola
Morocco World News   (08/04/2014)   Fatine Mexiane Elotmani
[Editor’s note: Find more information and read the Executive Order—Revised List of Quarantinable Communicable Diseases.]

Feature Profile in Public Health Law

Interview with Georgina Peacock

Title:
Medical Officer, CDC National Center on Birth Defects and Developmental Disabilities, Agency for Toxic Substances and Disease Registry

Education: 
BS University of Michigan, 1994 (Majors: Cell and Molecular Biology and German)
MD University of Kansas, Kansas City, 1999
MPH University of Kansas, Kansas City, 2006


PHLN: Please describe your career path.

Peacock: I began my work in public health during my developmental-behavioral fellowship at the University of Kansas.  Prior to this, I completed a bachelor of science in cell and molecular biology and German at the University of Michigan and medical degree and pediatric residency at the University of Kansas. I completed a master of public health during my fellowship. My practicum project involved implementing the “5 A Day nutrition” health campaign in a school for children with disabilities in Lima, Peru. As part of my MPH and fellowship work, I served on a taskforce to improve childcare quality in the state of Kansas. Following the completion of my fellowship, I moved to Atlanta to take a position as medical lead for “Learn the Signs. Act Early,” a program that works to support parents to understand early child development and identify early signs of developmental delay. During the 2009 H1N1 influenza pandemic, I served as the Children’s Health Team co-lead. Ultimately, this led to my leading the Children’s Preparedness Team for the Division of Birth Defects and Developmental Disabilities, beginning in 2012. 

PHLN: What drew you to working in public health, specifically in the area of pediatric preparedness?

Peacock: During my fellowship in developmental behavioral pediatrics, I spent a lot of my time diagnosing children with autism spectrum disorder and other developmental delays. That showed me how many of our individual health problems could be remedied only by addressing population health.  There are many people and systems that must work together to identify developmental delays early and get a child the help he or she needs. We can better prevent children from falling through the cracks by taking a broad view of the overall public health systems.

I developed a passion for pediatric preparedness while working in CDC’s Emergency Operations Center during the 2009–2010 H1N1 pandemic response. At that time, it was clear many issues specific to children are not addressed in preparedness plans, increasing the potential for morbidity and mortality.

PHLN: Please describe a typical workday.

Peacock: My job is all about partnerships—building capacity through improving knowledge and strengthening networks. I work with individuals, teams, and organizations to accomplish our goals. As a result, most of my day is spent working with people. If I’m not in a meeting or on a call, I’m likely at my desk responding to emails, reviewing materials, or working on papers and presentations related to children and preparedness. I do spend two half-days every month as a clinician, providing care to children with disabilities such as autism and developmental delay. This helps me stay connected to the children we serve and understand the daily realities of healthcare providers.

PHLN: Why is disaster planning for children unique?

Peacock: Children are more vulnerable than adults and have unique needs in emergencies and disasters. For example, they are smaller, have more permeable skin, and have higher respiratory rates than adults, which could make exposure to a substance a greater risk. They also have unique needs related to vaccines and medications. Additionally, they might not be able to communicate their symptoms or fears, making it more difficult to diagnose health problems or identify emotional concerns.

PHLN: August marked the inaugural meeting for the new Federal Advisory, the National Advisory Committee for Children in Disasters (NACCD). Why is the NACCD groundbreaking and important to public health and public health law?

Peacock: The Pandemic and All Hazards Preparedness Act, which provides the US Department of Health and Human Services (HHS) the funding and authority to conduct public health emergency preparedness activities, was reauthorized by Congress in 2013. This reauthorization brought a broad change in the language of the law, including emphasis on children in emergency planning, exercising, and medical countermeasure development and strategy. Furthermore, the law now calls for the establishment of an NACCD to advise the Secretary on matters of preparedness and response activities as they relate to the medical and public health needs of children. This advisory committee had its inaugural meeting August 7–August 8, 2014, and will continue to meet through 2018. The National Commission on Children and Disasters, a previous federal advisory committee that sunset in 2011, laid the groundwork for a lot of the great work focused on pediatrics. With an increased amount of attention on children’s issues, particularly in the realm of medical countermeasures, the NACCD has an opportunity to shape programmatic direction.

PHLN: What is your relationship with the new committee and what do you hope the committee will accomplish?

Peacock: I serve as CDC’s representative. The law calls for CDC’s director or his designee to be a member of the advisory committee. I hope we can work together to further ensure that the needs of children are met in public health disasters. I look forward to working with both federal colleagues from the HHS and the Departments of Education and Homeland Security, as well as the members representing groups external to the federal government to work toward this goal.

PHLN: What is the Strategic National Stockpile?

Peacock: CDC maintains large quantities of medicine and medical supplies that might be needed during an emergency. This is known as the Strategic National Stockpile or SNS. In the event a public health emergency, like pandemic flu or a terrorist attack where anthrax is released, certain medical supplies will be needed quickly in large quantities. The SNS can send these supplies to states that will further distribute them to local communities in need following the standards of the points of dispensing.

PHLN: You work on and with several integrated work groups, such as the Pediatric Obstetric Integrated Program Team. Will you please describe these groups and their purpose? What is your role within that team?

Peacock: I’m a member of several government groups that serve the needs of children in public health planning and response. The Pediatric Obstetric Integrated Program Team conducts yearly reviews of the items included in the SNS to help ensure there are supplies in the SNS to address the needs of pregnant women and children. This is part of the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE). The Pediatrics/Obstetrics Integrated Program Team reviews the SNS formulary every year to address children’s needs. It also assists in the development of product-specific requirements for developing new medical countermeasures (MCMs) to ensure children are protected.

I also am a CDC representative on the HHS CHILD work group. This group thinks strategically about children’s preparedness activities and shares information about current activities, addressing the needs of children, across HHS.

Outside of the federal government, I am the CDC liaison to the American Academy of Pediatrics Disaster Preparedness Advisory Council. This group works to ensure children are included in preparedness planning and that pediatricians are prepared to meet children’s needs, as well as their own, during a disaster.

PHLN: How is disaster planning through the integrated pediatric and obstetric workgroup related to public health law?

Peacock: The 2013 PAHPA reauthorization calls for improved approaches to assessing and evaluating MCMs for children and the strategies by which they are used. The law further calls for a focus on developing new MCMs or new formulations of existing MCMs that address children’s needs. PHEMCE—the overall federal government MCM development, procurement, and strategy enterprise— accomplishes its mission primarily through the evaluation of the contents of the Strategic National Stockpile. This annual review informs PHEMCE’s strategic direction by identifying gaps, areas of duplication, and opportunities for maximizing efficiency of use of MCMs stockpiled by CDC. Integrated program teams consist of representatives across HHS, including CDC. These teams participate in this review based on specific threat areas (e.g., anthrax or botulism) and cross-cutting concerns (e.g., pediatrics, obstetrics, and diagnostics).

In addition, this reauthorization called for the development of emergency use instructions (EUIs).  EUIs will improve the response during an emergency by providing MCMs to the public more efficiently.  Up until now, there have been emergency use authorizations, which are FDA authorizations to allow medications to be used in an emergency that normally do not have the required labeling and approval.  EUIs cover drugs that have been approved by the FDA, but do not have specific instructions on how to use them. The EUI provides these instructions. This increases the efficiency of MCM distribution during a public health emergency.

PHLN:  What other projects are you working on?

Peacock: I’m currently serving as acting division director for the Division of Human Development and Disability within CDC’s National Center on Birth Defects and Developmental Disabilities. It’s given me an opportunity to return to my roots with a focus on disability while still working to ensure that plans are in place to serve children and children and adults with disabilities during emergencies.

I’ve also been busy with preparedness activities. September is National Preparedness Month, and CDC is focusing on preparedness for vulnerable populations like children and people with disabilities. Our team assembled some great stories describing “Real Stories” from families and pediatricians about their experiences, lessons learned, and advice in emergencies.

PHLN: How can individuals and communities implement better emergency preparedness for children?

Peacock: That’s simple—include children in current planning. As you work through emergency preparedness plans, ask yourself, “What are we doing for children?” or, “Is it good for the children?” To answer this question, involve the community in your planning. If we plan for one of our most vulnerable groups, planning and response will be better for everyone. Consider working with local pediatricians, families with special healthcare needs, and community organizations that serve children to do this planning. When appropriate, use families and children as you work through disaster scenarios.

PHLN: What’s your favorite part or the most rewarding part of your job?

Peacock: I get to work with a team of passionate, smart people from a variety of different backgrounds to improve children’s lives. There is no better feeling than to go home knowing that the work our team and partners have done that day has made the lives of children a bit more secure should they experience a disaster.

PHLN: If you hadn’t chosen a career in public health, what other interest might you pursue?

Peacock: I would be working in a pediatric clinic, caring for children and families. What’s great is that with my current job, I can do both. I care for children in the clinic on some days and then work to improve systems on a population level the rest of the time.

PHLN: Have you read any good books lately?

Peacock: Several! My book club just read Somebody Else’s Love Story by Joshilyn Jackson. Among other things, it discussed the needs of children and adults with autism. I also read Midnight in the Garden of Good and Evil on a recent weekend getaway to Savannah. I spent the day walking to the different squares, reading a chapter in each square. It was fun to read something that took place right in the places I was sitting down to read. I also just read Year of Wonders by Geraldine Brooks, which told the story of a village hundreds of years ago where villagers put themselves into quarantine when the plague came to their town. It’s interesting to think about as new infectious diseases spread in our global society.

Finally, I recently read Strengths Based Leadership as part of my own professional development. I particularly liked learning about different leadership styles and how leaders achieve success through very different styles.

PHLN: Do you have any hobbies?

Peacock: As a mom of four, my main hobby is keeping up with my children. In my bits of spare time, I like to cook and try new recipes. I’ve lived around the world and like to cook ethnic food, whether it’s from my childhood years in Hong Kong or Peruvian chicken from the summer I spent doing my graduate dissertation in Lima, Peru.

I love to garden. I like to have flowers blooming year round, even if the weeds are blooming better than my plants! I also have a small vegetable garden that has given me more peppers and tomatoes than I know what to do with.

PHLN: Is there anything you would like to add?

Peacock: Follow your passions. I never imagined my career would bring me here, but I had a passion for serving children and people with disabilities. Stay focused on your mission, and it will take you to meaningful jobs.

Public Health Law News Quiz

The first reader to correctly answer the Quiz question will be given a mini-public health law profile in the October 2014 edition of the News. Entries should be emailed to PHLawProgram@cdc.gov with “PHL Quiz” as the subject heading. Entries without the heading will not be considered. Good luck!  


Public Health Law News Quiz Question: September 2014

According to the September 2014 top stories, what does “MAHC” stand for?

Public Health Law News Quiz Question August 2014 Winner!

Pameula S. Johnson


August Question: With what two organizations did the Public Health Law Program co-host a webinar titled “Ebola and the Law: What you Need to Know” on Tuesday, August 12, 2014? 

Winning response: 
The Network for Public Health Law
American Health Lawyers Association

A brief explanation of your job:
Design training objectives and coordinate different divisions of emergency services continuing education programs to include the Fire, Emergency Management and Emergency Medical Services.  

Education:
Associate degree in emergency medical sciences from Davidson County Community College in Lexington, North Carolina; bachelor of business administration from Catawba College, Salisbury, North Carolina; master of arts from Wake Forest University, Winston-Salem, North Carolina.

Favorite section of the News:
My favorite section of the News is the “Fifty Nifty,” which gives a run-down of all of the different public health laws within the different states and commonwealths. I like to read through them to see how something like this could affect my community locally.

Why are you interested in public health law?
My interest in public health law started in graduate school—looking at the ethical implications and how the laws affect a person in a community. I see public health as an all-embracing enterprise bonded by the common value of societal well-being. With the implementation of public health laws and the field gaining popularity, we hope to see reductions in health disparities among varying populations. As a life-long learner, and the lack of conceptual clarity [in the area of] of public health law as it develops, I will continue to study carefully the legal foundations, its ethical dimensions, and its relationship to human rights.

Do you have any hobbies?
I enjoy reading publications and studies on public health because my professional development is in emergency services. As for real hobbies, I enjoy martial arts, cooking out with family and friends, and occasionally camping and hiking.

Court Opinions

California: Court limits caregiver suits based on “primary assumption of risk” 
Gregory v. Cott
Supreme Court of California
Case No. S209125
Filed 08/04/2014
Opinion by Justice Carol A. Corrigan


Federal: Conflict of interest in Tobacco Products Scientific Advisory Committee 
Lorillard, Inc. v. US Food and Drug Administration
United States District Court, District of Columbia
Case No. 11-440 (RJL)
Decided 07/21/2014
Opinion by District Judge Richard J. Leon


Oregon: Developmental disability exclusion for autism violates state and federal law
AF ex rel. Legaard v. Providence Health Plan [PDF 310KB]
United States District Court for the District of Oregon
Case no. 3:13-cv-00776-SI
Filed 08/08/2014
Opinion by District Judge Michael H. Simon


Federal: Individuals in federal health exchanges ineligible for subsidized insurance
Halbig v. Burwell [PDF 422KB]
United States Court of Appeals for the District of Columbia Circuit
Case No. 14-5018
Decided 07/22/2014
Opinion by Judge Thomas B. Griffith

[Editor’s note: The full Court of Appeals for the District of Columbia Circuit has agreed to re-hear the case on December 18, 2014. Find more information by reading DC circuit court agrees to re-hear Obamacare case, published in the Huffington Post (09/04/2014)].

Quotation of the Month

Renee Reis, Aquatic Supervisor, Overland Park, Kansas

“I think people come in and think the pool is clean and it doesn't matter how I come in,” Renee Reis, Aquatic Supervisor, Overland Park, Kansas, said of public perception of pool safety and hygiene.

About Public Health Law News

The Public Health Law News is published the third Thursday of each month except holidays, plus special issues when warranted. It is distributed only in electronic form and is free of charge.

The News is published by the Public Health Law Program in the Office for State, Tribal, Local and Territorial Support.

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