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November 2013—CDC Public Health Law News

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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


Tools for landing a job in public health law, webinar with Matthew Penn. In this webinar hosted by the Network for Public Health Law, Matthew Penn, Director of CDC’s Public Health Law Program, will discuss the ins and outs of job searching and provide tips for successful cover letters, resumes, and interviews. A short Q&A session will follow. The webinar will take place on Friday, December 6, at 1:30 pm ET. Find more information and register for the webinar.

Distracted driving fatalities paper. In October 2013, Public Health Reports released a report from Public Health Law Research, “Fatalities of Pedestrians, Bicycle Riders, and Motorists Due to Distracted Driving Motor Vehicle Crashes in the U.S., 2005–2010.” The study identifies patterns in the demographic characteristics of distracted driving crashes, as well as the location of crashes. Find more information and read the open access paper.

Job openings with National Indian Health Board. The National Indian Health Board is seeking applicants for three career opportunities at their Washington, D.C. headquarters. The positions are 1) Director of Public Health Programs; 2) Tribal Health Care Reform Program Manager; and 3) Tribal Health Reform Policy and Program Associate. All positions are open until filled. Find more information and apply for the positions.

Faculty fellowships in public health law. Georgia State University College of Law and its Center for Law, Health & Society are leading an initiative funded by the Robert Wood Johnson Foundation for a faculty fellowship program to promote public health law education. Ten faculty members from law schools or schools/programs of public health will be selected to participate in a yearlong fellowship program. The program is open to all levels of faculty. The application period is open from September 3 to December 13, 3013. Letters of reference are due by December 6, 2013. Find complete eligibility requirements, program information, and apply for the fellowship.

NACCHO annual 2014 call for conference abstracts. The National Association of County and City Health Officials (NACCHO) Annual Conference workgroup seeks sharing session abstracts for the NACCHO Annual 2014 Conference, which will take place July 9–11, 2014, in Atlanta, Georgia. This year’s theme is “The New Era of Public Health: Science, Innovation, and Policy.” The deadline to submit session abstracts is Monday, December 16, 2013, 11:59 pm PST. Find more information about the conference and submitting an abstract.

2014 Public Health Law Conference. The 2014 Public Health Law Conference will take place October 16 and 17, 2014, in Atlanta, Georgia, and will gather public health and legal experts from across the country to examine and discuss today’s critical challenges in public health law. Find more information about the conference and learn how to get the early bird registration rate.

Legal Tools

Pseudoephedrine laws issue brief. The Centers for Disease Control and Prevention’s Public Health Law Program is releasing a new issue brief, Pseudoephedrine: Legal Efforts To Make It a Prescription-Only Drug, which provides an overview of legal efforts at the federal, state, and local levels to limit access to pseudoephedrine. Pseudoephedrine, the main ingredient used to make methamphetamine (meth), is a nasal decongestant typically found in nonprescription cold, allergy, and sinus medications, making it an easy source for people who operate illegal meth labs to obtain this precursor chemical.  Find more information and read the issue brief [PDF - 274KB].

Toolkit on preventing teen dating violence. The Robert Wood Johnson Foundation has released a new online toolkit on preventing teen dating violence in collaboration with Blue Shield of California Foundations and Futures without Violence. Find more information and access the toolkit.

Community benefit state law issue brief. The Hilltop Institute’s Hospital Community Benefit Program has released a second issue brief related to its online resource, the Community Benefit State Law Profiles. This brief, Hospital Community Benefits after the ACA: Policy Implications of the State Law Landscape, describes state community benefit requirements organized into eight categories that largely reflect either pre-existing federal community benefit standards or additional requirements set forth in §9007 of the Affordable Care Act (ACA). It also compares and contrasts various states and discusses the policy implications of the findings. Find more information and read the issue brief [PDF - 242KB].

Sugar-sweetened beverages playbook. ChangeLab Solutions has released their “Sugar-Sweetened Beverages Playbook,” offering a sequence of ten strategies—from public education campaigns to restrictions on the availability of sugar-sweetened beverages—communities and states can use. Find more information and download the playbook.

HIPAA Legal Tools

Top Stories

National: FDA ruling would all but eliminate trans fats
New York Times   (11/07/2013)   Sabrina Tavernise

On Thursday, November 7, 2013, the U.S. Food and Drug Administration (FDA) announced proposed measures that could effectively eliminate artificial trans fats from food for human consumption. Trans fats, which contribute to clogged arteries and heart disease, are made from partially hydrogenated oils.

Under the FDA’s proposal, partially hydrogenated oils would no longer be “generally recognized as safe,” a category of food ingredients which includes permissible substances such as caffeine and salt. Food companies are required to prove that ingredients that are not “generally recognized as safe” are in fact safe to eat. Removing partially hydrogenated oils and, by association, trans fats from this list would require food producers to prove that the added trans fats are safe, a heavy burden with the vast bulk of literature indicating that trans fats contribute to heart disease.

In 2006 the FDA released a rule requiring the inclusion of trans fats in menu labeling. Subsequently, many food producers chose to eliminate trans fats from their products. In spite of the progress, trans fats are still in many common processed foods.

“The artery is still half clogged. This is about preventing people from being exposed to a harmful chemical that most of the time they didn’t even know was there” said Dr. Thomas R. Frieden, Director for the Centers for Disease Control and Prevention.

The proposal is open for public comment until Monday, January 6, 2014.

[Editor’s note: Find more information and read the FDA’s proposal.]

New York: NYC council gets tough on tobacco, approves raising purchase age to 21
CNN   (11/01/2013)   Rande Laboni

On Wednesday, October 30, 2013, the New York City Council approved the “Tobacco 21” bill, an anti-tobacco law that raised the minimum tobacco-purchase age from eighteen to twenty-one. The bill includes a variety of tobacco products including electronic or e-cigarettes. Concurrent with approving the Tobacco 21 bill, the council also approved a bill prohibiting discounts on tobacco products and increasing tobacco tax enforcement.

Though neighboring states and counties have passed measures to increase the minimum tobacco-purchase age to nineteen, New York City is the largest city to have a tobacco age limit as high as twenty-one.

Reactions to the measures are mixed, with some New Yorkers disagreeing with the law. “You’re an adult; you should be able to buy a pack of cigarettes. I mean, you can think for yourself,” said one New Yorker to CNN affiliate NY1.

New York City Mayor, Michael Bloomberg, supports the measures. “By increasing the smoking age to twenty-one, we will help prevent another generation from the ill health and shorter life expectancy that comes with smoking,” said Bloomberg.

Bloomberg has 30 days to sign the bill into law, which would take effect 180 days after it is enacted.

[Editor’s note: Find more information about and read the tobacco measures.]

Briefly Noted

California: New licensing rules for app-based ridesharing companies
State regulators step in on ridesharing controversies   (10/10/2013)   Daniel C. Vock
[Editor’s note: Find more information about California’s passenger carrier licensing rules.]

Maine: State legislature seeks legislation to reduce overwhelming cancer fatalities
After losing 5 loved ones to cancer, Maine lawmaker turns tragedy to legislative action 
Bangor Daily News   (11/09/2013)   Mario Moretto

Minnesota: Nurses to be removed from direct patient care in light of criminal records
Minnesota will bar up to 107 nurses with criminal histories 
Star Tribune   (11/08/2013)   Brandon Stahl and Glenn Howatt

Wyoming: Seeking to improve safety by amending involuntary hospitalization law
Wyoming legislators support changes to involuntary hospitalization statute 
Start Tribune   (11/09/2013)   Megan Cassidy

National: Amish exempt from ACA, Amish communities continue to pay for care
As U.S. struggles with health reform, the Amish go their own way
NBC News   (10/06/2013)   Daniel Kelly

National: Consumers advised to be wary of insurance fraud and identity theft
Con men prey on confusion over health care act 
New York Times   (11/09/2013)   Jessica Silver-Greenberg and Susanne Craig

National: Fraudulent service animals difficult to investigate and prosecute under law
Fake service dogs a growing problem
NBC News   (10/10/2013)   Sue Manning
[Editor’s note: Find more information about service animals under the Americans with Disabilities Act.]

National: Authorities need sample before confirming presence of new illegal drug
Horrific flesh-rotting drug krokodil may be in Chicago, doctor says 
Los Angeles Times   (10/11/2013)

National: Voluntary relabeling of cold medicine may lead to law and policy changes
Warnings on children’s drugs found to help curb misuse 
New York Times   (11/11/2013)   Catherine Saint Louis

Feature Profile in Public Health Law

Carolyn Angus-Hornbuckle

Title: Public Health Communications and Program Manager, Public Health Programs

Organization: National Indian Health Board

Education: Juris Doctor from the Sandra Day O’Connor College of Law, Arizona State University

Tribe: Mohawk

CDC Public Health Law News (PHLN): What is the National Indian Health Board (NIHB) and what role does NIHB play in promoting tribal health care?

Hornbuckle: NIHB is a non-profit, charitable organization started by the tribes over forty years ago to serve the interests of tribal governments and citizens, as those interests relate to health and public health. NIHB is unique in its role as the only national tribal organization focused solely on health, serving all 567 federally recognized tribes. NIHB provides a range of services to Indian Country including policy review and analysis, legislative and regulatory tracking, program assessment and technical assistance, in-person and technology-based training, and research. As a core component of all of its work, NIHB provides direct and timely information to the tribes and fosters communication among the tribes and stakeholders in Washington and around the nation.

This year NIHB revised its vision statement. NIHB’s vision is to “provide one voice affirming and empowering American Indian and Alaska Native Peoples to protect and improve health and reduce health disparities.” This statement more fully reflects the role that public health plays in the overall health of American Indians and Alaska Natives, and the work that NIHB undertakes in service to the tribes.  

PHLN: Please describe your duties and responsibilities as the public health communications and program manager for the Department of Public Health Programs at NIHB.

Hornbuckle: My position encompasses a wide range of duties and responsibilities, touching a good number of the projects in NIHB’s Public Health Programs Department. For example, I work on NIHB’s Public Health Law Project. For that project, I provide outreach and education to those interested in using public health law as a public health tool. Those outreach and education efforts take the form of articles and stories in our publications, resources, and tools on our website, and trainings—both in-person and technology-based. NIHB has a number of important partners assisting us in this work including the National Congress of American Indians, the Network for Public Health Law, CDC, and others.

As another example, I also work on a project focused on suicide and methamphetamine (meth) use prevention.  For that project, I provide training and technical assistance to tribal programs working on those issues.  Although the focus of that project is not public health law, commonly encountered issues often touch upon law and policy. For instance, ensuring a continuum of care for those recovering from meth addiction may require a memorandum of understanding between several different tribal departments providing services. While it is not NIHB’s role to draft such a document, our role does compel us to ensure tribal programs are aware of that tool and what it can do to answer needs in the community.

I also work on a project that seeks to build the capacity of the tribes to prevent and treat HIV. With our partner on the project, the National Native American AIDS Prevention Center, NIHB provides outreach and education to reduce stigma and raise awareness of testing and treatment options. That project has included a major focus on clinical practices ensuring confidentiality and the laws enforcing it.

PHLN: What led you to work in the field of public health law?

Hornbuckle: When asked this question, I often reply that it was a fortuitous accident. I actually did not originally set out to work in public health law, but rather set out to serve the tribes and Native people in some capacity connected with health, education, or public safety.  This drive led me to work as a fellow in NIHB’s legislative department. 

In that position, I became more intensely aware of the limitations of health care and became more and more attracted to field of public health, which holds such incredible potential not only to save scarce financial resources, but more importantly, to prevent human suffering. Consider diabetes, for instance.  This is an area of tremendous disparity in Indian Country with American Indians and Alaska Natives experiencing diabetes at 2.8 times the national average. While it is true that type 2 diabetes can be managed by diet, exercise, blood monitoring and medication, it would be so much better if we could prevent people from developing diabetes in the first place. In so many areas of health, a public health approach just makes the most sense. 

Toward the end of my fellowship, NIHB’s Public Health Programs department had a position coming open and I applied to be considered for it. I got the position and quickly became immersed in the many different facets of public health. Although I really enjoy all of those aspects of the field, as an attorney, I have a special interest in public health law.

PHLN: Why is public heath law a significant part of NIHB’s work?

Hornbuckle: Law touches almost every aspect of the public health work taking place in Indian Country in some form. Because these aspects impact the tribes, they are a priority to NIHB.

As I mentioned before, many of NIHB’s public health projects include aspects of law or policy and a few of those projects really focus in on public health law. NIHB and tribes across Indian Country recognize the potential of a public health approach to many of the most pressing issues faced by American Indians and Alaska Natives. But tribes are more than interested parties, they are sovereign nations. As such, they can exercise their powers as sovereigns to address public health issues through law, if they so choose. This is important because, as we saw in the 20th century, public health laws often are responsible for some of the greatest achievements we see in public health. From immunization laws, to motor vehicle laws, to food safety laws, public health law has had an extraordinary role in keeping people safe and healthy. Tribes can use the tool of public health law to address the issues most critical to their citizens as well. Through outreach, NIHB can raise awareness of a public health law approach to these issues, and through training and technical assistance, we can help tribes achieve their public health goals.

PHLN: In your experience, what are some of the most pressing public health issues for tribes? 

Hornbuckle: Even as tribes are making incredible strides in preventing diabetes and other chronic diseases, we see many other health disparities emerge. Suicide has reached epidemic proportions in some parts of Indian Country, as has meth use. Unintentional injury continues to take a terrible toll on tribal communities, especially because injury often involves young people. Although these issues are formidable, tribes across Indian Country are redoubling their efforts to address them. Because NIHB is here to serve the tribes, we too are galvanized to raise awareness of the problems, provide analysis and recommendations, and assist as tribes press forward in this important work. 

PHLN: As a tribal public health lawyer and through your position at NIHB, are there any trends in tribes using public health law as a tool? If so, will you please describe those trends?

Hornbuckle: Because each Tribal Nation is unique, with their own unique community needs and determinations on how to best serve their citizens, it is difficult to say there are specific trends emerging. Tribal health departments use the latest research to inform their decisions, and therefore may end up working in similar areas based on that information. Tribes are developing distracted driving laws, built environment laws, and junk food taxes, for instance.

PHLN: How has NIHB been involved in facilitating tribal health care implementation of the Affordable Care Act (ACA)?

Hornbuckle: With partner organizations, NIHB has conducted extensive outreach and education on the ACA. We conduct this outreach and education by going out to Indian Country and hosting town hall types of events and more formal trainings, and events in between. We also have devoted portions of our national conferences to education on the ACA. Our outreach and education efforts target tribal citizens and also tribal leaders and health directors; we know that everyone needs to have information on how the law works and how it can work for them.

PHLN: What changes do you expect the ACA’s provisions to bring to American Indians and Alaska Natives?

Hornbuckle: The ACA made the Indian Health Care Improvement Act a permanent part of the health and public health landscape for American Indians and Alaska Natives, so it has already had a tremendous and positive impact. We also expect that the law will strengthen the Indian Health Service (IHS) overall, as people enroll in Medicaid, Medicare, and Veteran’s benefits. Once enrolled, these folks will be able to visit their IHS or tribal clinic or hospital and have their care funded by those other agencies. The money saved by the IHS or tribal clinic can be used for other patients. Given the fact that IHS is funded at a little over half of need, the third party billing advanced by the ACA will likely have a profound positive impact on Indian Country. 

PHLN: How can individuals and professionals learn more about NIHB and tribal public health law?

Hornbuckle: We hope that individuals will visit our website, join us at our national conferences and reach out to us by phone or email. We serve all federally recognized tribes and we welcome those interested in the field of public health law to join us in our efforts to improve the health and wellness of American Indians and Alaska Natives.

PHLN: If you were not working in public health law, what would you likely be doing?

Hornbuckle: I have always loved writing, so I think I would probably be working on a book. Who knows—some of the best stories are about public health—maybe I would write a story connected with public health. 

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

Hornbuckle: I love to travel. I have had the opportunity to visit many places, but there are still many more that are on my bucket list. I would love to go to Russia and China. Seeing interesting places and seeing how other people live is fascinating. The world is such an interesting place.

Court Opinions

Iowa: Factual basis for guilty plea in HIV transmission case, counsel not ineffective
Rhoades v. State of Iowa [PDF - 146KB]
Court of Appeals of Iowa
Case No. 3-572/12-0180
Decided 10/02/2013
Opinion by Judge Richard H. Doyle

Minnesota: Foul-smelling shavings warrant a search of snake breeder’s home
Nellis v. City of Coon Rapids Board of Adjustment and Appeals
Court of Appeals of Minnesota
Case No. A13-0191
Decided 09/30/2013
Opinion by Judge Francis J. Connolly

Federal: Defendants not dismissed for DEA’s failure to comply with the Dangerous Drug Diversion Control Act
United States v. Nasir
United States District Court, Eastern District of Kentucky, Central Division, Lexington
Case No. 5:12-CR-103-JMH
Decided 09/25/2013
Opinion by Senior District Judge Joseph M. Hood

Federal: City’s ban on tobacco coupons not barred by First Amendment
National Association of Tobacco Outlets, Inc. v. City of Providence, Rhode Island
United States Court of Appeals, First Circuit
Case No. 13-1053
Decided 09/20/2013
Opinion by Judge Timothy B. Dyk

Federal: Injunction in contraceptive coverage upheld pending SCOTUS ruling
Newland v. Sebelius [PDF - 28KB]
United States Court of Appeals, Tenth Circuit
Case No. 12-1380
Decided 10/03/2013
Opinion by Judge Scott M. Matheson, Jr.

Quotation of the Month

Dr. Thomas R. Frieden, Director of the Centers for Disease Control and Prevention

“The artery is still half clogged. This is about preventing people from being exposed to a harmful chemical that most of the time they didn’t even know was there,” said Dr. Thomas R. Frieden, Director for the Centers for Disease Control and Prevention, of progress made in removing trans fats from food products.  

About Public Health Law News

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

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


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