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July 2013—CDC Public Health Law News

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Thursday, July 18, 2013

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

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In this Edition


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 be provided with tailored information about health insurance premiums and coverage options. Find more information about the Health Insurance Marketplace.

Webinar: Efforts, Challenges, and Successes of Policies to Reduce Sodium Intake in the U.S. Public Health Law Research and the American Society of Law, Medicine & Ethics will present this webinar on Thursday, July 18, 2013 from 1 to 2 p.m. (EDT). The webinar will address the importance of sodium reduction as a public health goal in the United States; highlight the regulatory and voluntary efforts of government and industry; describe implementation issues from the regulatory and voluntary aspects; discuss the unintended consequences of these efforts and the challenge in finding the best solutions; and discuss successes and best practices that have resulted in notable sodium reduction measures. Find more information and register for the webinar.

Public Health Law Research opens 5th call for proposals. Public Health Law Research has released its fifth call for proposals. Approximately $1 million for short-term studies will be awarded, with eighteen-month awards of up to $150,000 for each study. The program seeks to build the evidence for and strengthen the use of regulatory, legal, and policy solutions to improve public health and help people lead healthier lives. The deadline for submitting full proposals is July 24, 2013, at 3 p.m. (EDT). Find more information about Public Health Law Research and proposal requirements.

'PHLR: Theory and Methods' now available. Public Health Law Research has published a new book, "Public Health Law Research: Theory and Methods." It explores the mechanisms, theories, and models central to public health law research. The book covers framing public health law research, understanding how law influences the environment and behavior, identifying and measuring legal variables, and designing public health law evaluations. Find more information about Public Health Law Research and PHLR: Theory and Methods.

Legal Tools

Domestic and sexual violence screening toolkit. In February of 2013, the U.S. Preventive Services Task Force issued new recommendations to support screening and response to intimate partner violence, also known as domestic violence, and recommended that health plans provide the service. The National Health Resource Center on Domestic Violence created this toolkit which offers health care providers and advocates for victims tools to prepare a clinical practice to address domestic and sexual violence. The toolkit includes screening instruments; sample scripts for providers; patient and provider education resources; and strategies for forging partnerships between health care and domestic and sexual violence programs. Find more information and access the toolkit.

Community benefit state law profiles. The Hilltop Institute has released Community Benefit State Law Profiles (Profiles) which present a comprehensive analysis of each state's community benefit landscape as defined by its laws, regulations, tax exemptions, and, in some cases, policies and activities of state executive agencies. The Profiles organize these state-level legal frameworks by the major categories of federal community benefit requirements found in § 9007 of the Affordable Care Act (ACA), § 501(r) of the Internal Revenue Code. Find more information and access the Profiles.

Top Stories

The Fifty Nifty United States—Public health law news from every state

Alabama: New law makes it a crime to threaten on-duty utility workers
New laws take effect today
Montgomery Adviser   (06/30/2013)   Phillip Rawls

Alaska: No statutes of limitations on child pornography or human trafficking prosecution
New laws take effect in Alaska on July 1   (06/30/2013)
[Editor's Note: Find more information and read Alaska's SB 22.]

Arizona: Appellate Court says convicted felons not required to pay for DNA testing
State v. Reyes [PDF - 95KB]
The Court of Appeals, State of Arizona, Division One
Case No. 1 CA-CR 12-0163
Decided 07/02/2013
Opinion by Judge Maurice Portley

Arkansas: Alcoholic Beverage Control Board writes wine shipping rules under new law
Board at work on rules for shipping Arkansas wine
San Francisco Gate   (07/06/2013)
[Editor's note: Learn more about Arkansas's Alcoholic Beverage Control Board and read the Alcoholic Beverage Rules and Regulations.]

California: Duarte, California passes e-cigarette sale moratorium
E-cigarette technology smoking hot while cities struggle with regulations
San Gabriel Valley Tribune   (07/07/2013)   Sarah Favot

Colorado: Potentially biased lab results could further backlog in drug prosecutions
Defense attorneys fear blood-test backlog during state lab suspension
Denver Post   (07/07/2013)   Jordan Steffen

Connecticut: Emergency storm preparation measures without building permit
New laws help shoreline owners
Connecticut Post   (07/05/2013)   Michael P. Mayko
[Find more information and read Connecticut Public Act No. 13-179.]

Delaware: Child Victim Unit to unite justice and social services depts.
Attorney general establishes special child abuse squad
Delaware Online   (07/02/2013)   Terri Sanginiti

Florida: Employees training to answer questions regarding insurance exchange
Florida expects plenty of questions as health exchanges come online
Tampa Bay Times   (07/05/2013)   Tia Mitchell
[Find more information about the Health Insurance Marketplace.]

Georgia: Children still exposed to lead though paints banned almost forty years ago
Lead still causing health problems in north Georgia
Dalton Daily Citizen   (07/01/2013)   Charles Oliver
[Editor's note: Learn more about lead exposure and prevention.]

Hawaii: Community Health Needs Assessment released, part of state-wide collaboration
Hawaii releases first statewide assessment of community health needs
Pacific Business News   (07/03/2013)   Landess Kearns
[Editor's note: Find more information and read Hawaii's Community Health Needs Assessments.]

Idaho: Sixty-six citations for texting while driving
Idaho marks 1-year ban on texting while driving
Idaho State Journal   (07/07/2013)

Illinois: Law requires school shooting safety drills with local law enforcement
Quinn signs bill requiring schools to hold shooting safety drills
Chicago Tribune   (07/01/2013)   Monique Garcia
[Editor's note: Find more information and read Illinois Public Act 098-0048.]

Indiana: New rules and policy for isolating and restraining students
Student restraint rules changing in Indiana
Indiana Star   (07/07/2013)   Eric Weddle

Iowa: Forty-seven counties receive Presidential Disaster Declaration
Iowa receives Presidential Disaster Declaration
Oskaloosa News   (07/02/2013)  
[Editor's note: Find more information about the Presidential Disaster Declaration.]

Kansas: Over $300,000 to be refunded to state in prescription drug settlement
Kansas joins in national settlement with pharma company
Capital Journal   (07/03/2013)

Kentucky: Stiffer penalties for human trafficking convictions
New KY laws dealing with dropout age, religious beliefs take effect Tuesday   (06/24/2013)   Beth Musgrave
[Editor's note: Find more information and read the new law.]

Louisiana: Bigamy and human trafficking added to racketeering law
Jindal signs bill adding human trafficking, bigamy, to Louisiana racketeering laws
Bayou Buzz   (06/10/2013)  
[Editor's note: Find more information and read Louisiana Act 144.]

Maine: Increased oversight and written standards for guardians ad litem
Guardian ad litem reforms praised by supporters; LePage to sign bill Monday
Bangor Daily News   (07/07/2013)   Judy Harrison
[Editor's note: Find more information about Main LD 872.]

Maryland: Residential smoke alarms to have long-life, sealed-in batteries
Maryland updates smoke alarm law
Herald Mail   (07/07/2013)   Holly Shok
[Editor's note: Find more information and read Maryland Senate Bill 969.]

Massachusetts: Bill would allow employees to sue over workplace bullying
Proposal in Mass. targets bullying at work   (06/24/2013)  
[Editor's note: Read the Healthy Workplace Bill.]

Michigan: Law allows vintners to offer tastings at farmers markets 
Snyder Oks wetland permit law, wine tasting at farmers markets
Lansing State Journal   (07/03/2013)  
[Editor's note: Find more information about Michigan SB 0079.]

Minnesota: Lawmakers concerned synthetic drugs straining healthcare system
Legislative panel on synthetic drugs to hold first hearing
Minnesota Public Radio   (07/07/2013)   Rupa Shenoy

Mississippi: State legalizes homebrewing alcohol, now legal in all fifty states
Homebrewing legal in all 50 states after Mississippi law takes effect
Business Journal   (07/04/2013)   Jeff Engel

Missouri: Law requires Pule Oximetry test before newborns discharged from hospital
Chloe's Law to be signed by Gov. Nixon
CBS St. Louis   (07/08/2013) 
[Editor's note: Find more information and read Chloe's Law.]

Montana: Lowering legal alcohol limit may not discourage intoxicated driving
Officials: Lower BAC limit will not lessen Montana's DUI problem
Missoulian   (06/17/2013)   John Grant Emeigh

Nebraska: State uses statewide emergency text system for Amber Alert
First statewide use of cellphone text alert caught many by surprise   (06/25/2013)   Paul Hammel

Nevada: Hospital implements changes in wake of patient-dumping allegations
State completes review of improper patient discharges at Rawson-Neal Psychiatric Hospital
Las Vegas Review Journal   (06/27/2013)   Yesenia Amaro

New Hampshire: State of emergency declared after flooding in several counties
Hassan declares state of emergency as heavy rain causes flooding in NH
Concord Monitor   (07/03/2013)   Ben Leubsdorf

New Jersey: Bill would ease access to medical marijuana for seriously ill children
Christie still reluctant on making medical marijuana program more accessible to kids   (07/03/2013)   Susan K. Livio

New Mexico: $1 million federal grant to help provide medical care to uninsured children
New Mexico receiving $1M federal grant to enroll kids in health care programs
The Republic   (07/03/2013)  

New York: Bill allows pharmacist to give meningitis vaccination
Legislature approves bill allowing pharmacists to give meningitis vaccinationNew York Times   (06/23/2013)   Anemona Hartocollis
[Editor's note: Find more information about New York Senate Bill 4881-A

North Carolina: 'Commonsense Consumption Act' would limit suits against food manufacturers
NC Senate agrees to block food consumption suits
News and Record   (07/01/2013)
[Editor's note: Find more information about the proposed Commonsense Consumption Act.]

North Dakota: Law limits personal information from public motor vehicle crash reports
ND public records bill a compromise
The Forum of Fargo-Moorhead   (07/05/2013)   Wendy Reuer
[Editor's note: Find more information and read North Dakota Senate Bill No 2310.]

Ohio: Bipartisan bill would ban teens' use of tanning beds
Lawmakers looking to ban minors from using tanning beds   (07/05/2013)   Brandon Blackwell
[Editor's note: Find more information about Ohio House Bill 131.]

Oklahoma: Prescription painkiller abuse linked to overdose deaths
Painkiller overdose deaths grow among Oklahoma women
News OK   (07/02/2013)   Carmen Forman

Oregon: More difficult for parents to opt out of vaccinations for non-medical reasons
Oregon House approves bill tightening rules for parents who opt children out of immunizations
Oregon Live   (06/19/2013)   Yuxing Zheng
[Editor's note: Find more information about and read Oregon Senate Bill 132 [PDF - 30KB].]

Pennsylvania: Court holds schools have no legal obligation to protect from bullying
Morrow v. Blackhawk School District [PDF - 800KB]
United States Court of Appeals for the Third Circuit
Case No. 11-2000
Filed 06/05/2013
Opinion by Chief Circuit Judge Theodore A. McKee

Rhode Island: Defibrillator and CPR training graduation requirements under new law
CPR skills now required to graduate RI high schools
WPRI   (06/25/2013)

South Carolina: Firework stand inspection law supported by owners as more consistent and safer
SC fireworks law change improving safety, stand owners say
WBTW News 13   (07/04/2013)   Robert Kittle

South Dakota: Young drivers with restricted licenses banned from using cellphones
Three new laws in effect today: School sentinels, teen driving, new crime focus
Argus Leader   (07/01/2013)
[Editor's note: Find more information and read South Dakota Senate Bill 106.]

Tennessee: Changes in evidence collection could lead to more DUI convictions 
Tennessee to see more DUI convictions
Times Free Press   (07/02/2013)   Todd South

Texas: Law gives state dental board more authority to investigate complaints 
Texas law cracks down on unnecessary dental treatments   (06/27/2013)   David Heath

Utah: Law bans smoking in cars with passengers under sixteen
New laws kick in around US; here are Utah changes
Bloomberg Businessweek   (07/01/2013) 
[Editor's note: Find more information and read Utah HB13.]

Vermont: New law allows beer shipments to private individuals 
New laws for drivers, beer drinkers, and bird lovers
Burlington Free Press   (07/01/2013)   Nancy Remsen
[Editor's note: Find more information and read Vermont Bill H174 [PDF - 24KB].]

Virginia: Victim compensation fund rules questioned
VA could revisit rules for victim compensation fund
Times Dispatch   (07/08/2013)   Frank Green

Washington: State grapples with image after recreational marijuana law
State lets marijuana leaf logo loose
News Tribune   (07/05/2013)   Jonathan Kaminsky

West Virginia: Failure to wear seatbelt primary offense under new law 
New seat belt law goes into effect in West Virginia on Tuesday
WTRF 7   (07/08/2013)  
[Editor's note: Find more information and read West Virginia HB 2018.]

Wisconsin: Higher premiums for state workers who smoke vetoed
Wisconsin Governor Scott Walker vetoes tobacco surcharge
Post Crescent   (07/01/2013)

Wyoming: Last state to enact human trafficking laws 
New Wyoming laws start Monday
Wyoming News   (07/01/2013)   Trevor Brown
[Editor's note: Find more information and read Wyoming House Bill 0133 [PDF - 47KB].]

International: World Health Organization convenes emergency MERS-CoV committee 
WHO emergency committee prepares as Coronavirus MERS-CoV death toll rises
Forextv   (07/05/2013)   Lisa Judd
[Editor's note: Find more information about Coronavirus (MERS-CoV) and the 2013 Cornavirus Emergency Use Authorization (Potential Emergency).

Feature Profile in Public Health Law

Ellen Lawton

Title: Co-Principal Investigator, National Center for Medical-Legal Partnership at the George Washington University School of Public Health and Health Services

Education: J.D. (Northeastern University School of Law), B.A. (Union College)

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

Lawton: I've always worked in the public interest sector, even before I went to law school. For me, public health law represents one of the best ways to positively impact people in communities around the country. 

PHLN: Please describe your career path to the National Center for Medical-Legal Partnership (NCMLP).

Lawton: After law school, I clerked for a Massachusetts Appellate Court judge, which helped me realize that I really needed to work directly with people and not in a library researching case law!  From there I became a litigator at the Massachusetts Department of Social Services, representing the state in child protection cases. I saw first-hand the horrendous effects of poverty and disparities on families and communities. I left that position in 1997 to work as one of the first attorneys at Boston Medical Center's medical-legal partnership (MLP). For me, it represented an incredible opportunity to use my legal skills to prevent some of the dire outcomes I witnessed in the child protection world. I became the MLP's director in 2001, and co-founded the National Center for Medical-Legal Partnership (NCMLP) in 2006.

PHLN: What is a medical-legal partnership and what forms can such a partnership take?

Lawton: One in six Americans live in poverty, and every single one of those individuals has some sort of civil legal problem that negatively impacts their health. But despite this health/law connection and the fact that civil legal aid offices and health care institutions have long treated the same patients or clients, there's never been a coordinated effort to address these problems, or to understand that many legal problems are health problems. That's where a MLP comes in.

An MLP is a healthcare delivery model that integrates legal care directly into patient health care, and uses three levels of legal interventions—at the patient, clinic, and policy levels—to address and prevent health-harming legal needs. Within every category of the social determinants of health, there are specific problems that cannot be addressed without the expertise of an attorney. There are families wrongfully denied food supports and educational benefits, necessary resources to meet their daily needs. There are children living in housing with mold or rodents, in clear violation of housing laws, whose physical environment makes them sick. And there are seniors being denied long-term care coverage they're entitled to, whose lack of access to insurance prevents them from getting the medical care they need.

While the core of every MLP is the same—an existing health care institution and an existing legal institution coming together to integrate their services and address these issues—one of the best parts of the model is its flexibility to respond to the local needs and resources of a particular community. More than 300 hospitals and health centers in the United States have developed MLPs in a range of healthcare settings, including rural and urban community health centers; disproportionate share and children's hospitals; veterans medical centers; and specialty care. They address the needs of children, families, veterans, chronically ill individuals, and the elderly.

PHLN: What are the origins of MLPs?

Lawton: The first MLP emerged from Boston Medical Center's pediatrics department in 1993 when the first lawyer was hired to help address housing conditions—such as mold and rodent infestations—that were negatively impacting child health, especially for kids with asthma. But there are many critical antecedents to MLP—examples where legal and health partners have come together over the years to address local issues related to the social determinants of health—like the provision of legal services in the care of HIV/AIDS patients in the 1980s. Dr. Jack Geiger, founder of the community health center model and a member of the NCMLP Advisory Council, speaks eloquently of an even earlier example, hiring a lawyer at the first community health center in Mississippi in the 1960s to handle discrimination and other legal issues that plagued the community.

PHLN: Can you give an example of how MLPs cooperate for patient/client care?

Lawton: MLPs provide patients three levels of legal care. First, at the individual level, when health care teams are trained to detect and manage legal problems related to health—such as the family who has been threatened with eviction for complaining about rodent infestation. Working together, the health and legal teams can ensure that landlords understand their responsibilities in addressing sanitary conditions, and hold them accountable for maintaining safe, healthy housing. The second level is legal care at the clinic level—building healthcare team capacity to address health-related legal problems through regular training, integration of screening and intervention tools into the electronic health record, and tracking patterns of legal issues that might benefit from policy intervention. And finally, at the policy level, where NCMLP medical director Dr. Megan Sandel talks about MLPs' ability to target failed policies with the twin expertise of lawyers and healthcare providers, for more effective policy advocacy at the local, state, and federal levels.

PHLN: Who benefits from MLPs and how?

Lawton: First and foremost, patient-clients benefit from the addition of legal expertise to the patient care team and from the elevation of healthcare provider voice in policy decisions and regulations. But the professions themselves benefit in big ways too. On the health care side, MLP builds capacity to handle patient legal needs, allowing healthcare team members to work at the top of their profession, rather than struggling to navigate complex government bureaucracies. Healthcare institutions benefit from a return on investment (documented through excellent research at Southern Illinois Healthcare [PDF - 812KB]) and by helping control costs for especially high users of healthcare resources. The civil legal aid community benefits from the ability to prevent legal problems, rather than simply react to legal problems that plague vulnerable communities, expanding their capacity to provide care.

PHLN: What is the NCMLP and how does it create and support MLPs?

Lawton: NCMLP is a project inside the George Washington University School of Public Health and Public Health Services' Department of Health Policy that leads research and policy activities to sustain and scale the MLP model of care and to align health, legal, corporate, and government partners to alleviate legal barriers to health and healthcare. NCMLP is funded by the Kresge and Robert Wood Johnson Foundations.

Between 1993 and 2005, the number of healthcare institutions with an MLP grew from one to almost 75. It was a grassroots movement with individuals hearing about the model and building partnerships in their communities. But the growing interest in MLPs and the need to promote the model consistently was a catalyst for developing the NCMLP in 2006.

Today, we develop and disseminate technical assistance materials and toolkits to emerging partnerships and promote learning across the nearly 300 program sites at our annual national summit and across social media platforms. We convene government and professional stakeholders on specific projects to integrate MLPs into existing healthcare strategies and innovations, such as emerging quality measures for chronic disease. And we work to develop consistent metrics for MLPs that can be used by the health and legal communities to measure the impact of their work.

PHLN: What role does public health data play in MLPs and why is it important?

Lawton: Interestingly, a number of the public health priorities in communities across the United States are responsive to, or ameliorated by, civil legal aid interventions alongside public health strategies, whether infant mortality, asthma rates, or the impact of chronic diseases on low-income populations. But the traditional civil legal aid community doesn't have the statistical and analytical capacity of the public health community, and struggles to track the prevalence of legal needs and the effectiveness of its interventions. At NCMLP, we believe that civil legal aid expertise and infrastructure could be more strategically deployed to greater impact if the civil legal aid community truly partnered and synchronized with the health and public health communities. 

PHLN: How can this data improve public health more broadly?

Lawton: As the broader health community better understands and tracks the skills and impact of civil legal services, they'll begin to see that the chronic, pervasive underfunding of civil legal services at the federal and state levels compromises public health and can be a linchpin for improving community health. The field of social determinants of health has focused understandably on measuring and describing the baseline in communities. Increasingly, we see MLPs as one of the few solutions that leverages existing skilled resources to produce a multiplicity of positive impacts in the clinical and public health struggle to address the social determinants of health.

PHLN: As you look to the transformation of our health system, what do you think the future holds for MLPs?

Lawton: There's no question that the shifting of the health care landscape to expand both direct access to health care services, and support for prevention activities, provides an opportune time to integrate an innovation like MLPs. As the healthcare team broadens to include new members like patient navigators and community health workers, it's crucial to include skilled legal aid attorneys who can boost the impact and productivity of those new team members and address a unique subset of social determinants of health that no other profession can, all while having a correspondingly positive impact on the millions of vulnerable people who come into the legal aid system every year.

PHLN: What role do you see medical-legal partnerships playing in the emerging accountable care delivery model?

Lawton: There is no question that the accountable care delivery model creates substantial opportunities to draw in strong, impactful community resources like legal aid closer to the healthcare setting, and in the process creating accountability as well as more seamless access for vulnerable patients.  In the current landscape, patients who experience health-harming legal needs that are identified in a clinical setting that doesn't have an MLP must forge their own way, seeking out limited community legal resources that are not necessarily situated in close proximity to the health institution, nor are they experienced at interfacing with health care teams to achieve more effective cross-collaboration.  MLPs can change that dynamic, and ACOs create the perfect environment for MLP to flourish.

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

Lawton: This is a really exciting time for NCMLP as our own growth is aligning with opportunities in health reform. The Division of Health Resources and Services Administration (HRSA) at the Department of Health and Human Services made an early investment in a small demonstration project to integrate MLPs with Healthy Start home visiting programs in three sites. The pilot was extremely successful, and we are poised to disseminate those findings and work with HRSA to expand their role in MLP.

At the same time, the Department of Veterans Affairs (VA) has taken a real leadership role in HCMLP, and has already brought in some level of legal care into 38 of its medical centers, and has 4 active and several emerging MLPs. We’re in the early stages of working with them to develop evaluation metrics for VA-based MLPs. One of our lead funders, The Kresge Foundation, just invested in a multi-year project supporting MLP in nurse-managed health centers.

The private sector is also driving innovation in MLP. Some of our earliest and strongest leaders are in children's hospitals, and we're about to announce a learning network with a core group of children's hospitals that have strong MLP programs that's being backed by multiple corporate pro bono partners.

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

Lawton: I can't imagine not working in this field! If I weren't focused on MLPs, I think that I would work on changing the conversation in the United States about advanced care and end-of-life.

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

Lawton: I have two active boys so I need to keep in shape to keep up with them! We like tennis, swimming, biking, and camping. And my husband and I are avid comedy aficionados—Aziz Ansari and Jim Gaffigan are two favorites.

PHLN: Have you read any good books lately?

Lawton: I'm still recovering from the heart-stopping Gone Girl. Better still is the new TED book by my friend and colleague Dr. Rishi Manchanda, The Upstream Doctors—it's the ultimate public health manifesto!

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

Lawton: I'm often referred to as a goodwill ambassador for the legal profession, a title I wear proudly! I believe that the legal community in general, and the civil legal aid community specifically, has a terrific expertise to bring to the cause of clinical and public health. I look forward to the days when we have a more accessible common language and better understanding of our combined strengths.

[Editor's note: Find more information about medical-legal partnerships across the nation.]

Quotation of the Month

State Representative Terry Backer on Connecticut's new shoreline construction laws

"What we fail to understand is that we live on a moveable shoreline and have to design our plans for future changes. New Construction has to be vigilant as to how close to the water it can be," said Connecticut State Representative Terry Backer of Connecticut's new laws regarding coastline construction before and after storms.

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 N ews is published by the CDC Public Health Law Program in the Office for State, Tribal, Local and Territorial Support.


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