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March 2014—Public Health Law News

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In This Edition


Webinar on Community Health Needs Assessment requirements. CDC’s Public Health Law Program and the Network for Public Health Law are co-hosting a webinar on Wednesday, March 26, 2014, at 2:00–3:30 p.m. (EDT). The webinar will feature Molly Berkery from CDC’s Public Health Law Program and Professor Mary Crossley from the University of Pittsburgh School of Law, and will discuss the new community health needs assessment (CHNA) requirements for charitable 501(c)(3) hospitals. Ms. Berkery will provide an overview of the CHNA legal framework and CDC resources for implementing the CHNA process. Professor Crossley will describe strategies for moving from the “assessment” stage to broader population health initiatives and highlight how such community investments may provide a solid return on investment for hospitals in a changing healthcare environment. Information on Continuing Legal Education credit is available upon request from the Network for Public Health Law. Contact Jackie Rose at 651-695-7636 or Find more information and register for the free webinar.

CDC Public Health Law Program Externship. The CDC Externship in Public Health Law consists of 9–14 weeks of professional work experience, for academic credit, with CDC’s Public Health Law Program 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 externship is open to second and third year law students who are interested in exploring careers in public health law. Participants must receive academic credit. Applications for the fall 2014 program must be submitted by May 31, 2014, and spring 2015 applications must be submitted by November 1, 2014. Find more information and apply for the externship program.

Healthcare Marketplace open enrollment period ends on March 31, 2014. Find more information about the Healthcare Marketplace and apply for health insurance coverage.

Regulating non-medical marijuana webinar. The “Regulating Non-Medical Marijuana—Lessons Learned and Paths Forward” webinar, hosted by the Network for Public Health Law, will provide an overview of issues related to non-medical marijuana regulation through lessons learned from decades of alcohol and tobacco regulation, along with insights from Washington State’s recent implementation of a marijuana law. The webinar will also examine implications for drug policy and enforcement, as well as health department structure. The webinar will take place on Thursday April 17, 2014, at 1:00 p.m. (EDT). Find more information and register for the webinar.

O’Neill Institute Summer Program. The O’Neill Institute for National and Global Health Law at Georgetown University will present two summer 2014 programs: 1) Emerging Issues in Food and Drug Law and 2) U.S. Health Reform—The Affordable Care Act. The summer programs convene leading practitioners, policymakers, advocates, and academics in food and drug law and U.S. healthcare reform for a series of interactive lectures, panel discussions, and case studies. Held during consecutive weeks, July 14–18 (Emerging Issues in Food and Drug Law) and July 21–25 (U.S. Health Reform—The Affordable Care Act), interested participants may attend one or both programs. Invited speakers include current and former officials from the Department of Health and Human Services, the Food and Drug Administration, the Federal Trade Commission, the Environmental Protection Agency, as well as former U.S. congressional staff involved in the adoption and implementation of the Affordable Care Act. Register by April 15, 2014, for the discounted rate; the final registration deadline is June 15, 2014. Find more information and apply for the summer 2014 programs.  

National Association of County and City Health Officials 2014 Preparedness Summit. The 2014 Preparedness Summit will take place April 1–4, 2014, in Atlanta, Georgia. The event will provide one of the only cross-disciplinary learning opportunities in the field. The diverse range of attendees will include professionals working in all levels of government (local, state, and federal), emergency management, volunteer organizations, and healthcare coalitions. Find more information and register for the 2014 Preparedness Summit.

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. Find more information about the conference and learn how to get the early bird registration rate.

Georgia State University Faculty Fellowships Awarded. Georgia State University College of Law and its Center for Law Health & Society have selected ten faculty fellows to participate in the Future of Public Health Law Education: Faculty Fellowship Program. The fellows, chosen from across the country, will develop interdisciplinary courses and programs in public health law at their respective universities during the fellowship year. Their projects will strengthen interdisciplinary education in public health law and promote collaborations with public health agencies and organizations in the fellows’ communities. The program is funded by the Robert Wood Johnson Foundation to foster innovations and build a learning community among those who teach public health law at professional and graduate schools. Find more information about the  faculty fellowships and faculty fellows

Legal Tools

Public health emergency law minimum competencies. CDC’s Public Health Law Program released the Public Health Emergency Law Competency (PHEL) Model Version 1.0, a model set of minimum competencies in public health emergency law will help mid-tier public health professionals to advance the inclusion of law-based content in all public health emergency training, resources, and tools. The PHEL competencies were developed at the request of CDC’s Office of Public Health Preparedness and Emergency Response and the Association of Schools of Public Health as a companion document to the Public Health Preparedness and Response (PHPR) Core Competency Model for mid-level public health workers and the supporting Knowledge, Skills, and Attitudes for the PHPR Core Competencies. Find more information and download the Public Health Emergency Law Competency Model Version 1.0.

Menus assessing state prescription drug overdose laws. CDC’s Public Health Law Program is pleased to release several menus assessing state prescription drug overdose laws: Menu of State Prescription Drug Identification Laws [PDF 332KB]Menu of Pain Management Clinic Regulation [PDF 235KB]; and Menu of State Laws Related to Prescription Drug Overdose Emergencies [PDF 176KB]. These resources are designed to provide a picture of some of the legal and regulatory strategies states have used to address prescription drug misuse, abuse, and overdose. These menus were created through a partnership between CDC’s Public Health Law Program and National Center for Injury Prevention and Control.

Performance Standards for Restaurants. The RAND Corporation has released Performance Standards for Restaurants based on guidelines for healthier adult and children’s restaurant meals developed by a group of experts. The standards, released fall 2013, include recommendations for calories, fats, sugars, and sodium, and servings of vegetables, fruit, and whole grains. Healthier restaurant practices were also identified. The restaurant performance standards can be used as a model for states, localities, or nonprofit organizations when developing restaurant policies or certification programs. Find more information and access the Performance Standards for Restaurants.

Association of State and Territorial Health Officials fact sheets to increase use of law. The Partnership for Public Health Law, a Robert Wood Johnson Foundation funded collaborative between the Association of State and Territorial Health Officials, the American Public Health Association, National Association of County and City Health Officials, and the National Association of Local Boards of Health, has developed six fact sheets to help increase the knowledge and use of law among the partner organizations and their members. The fact sheets provide a broad overview of public health law and discuss legal issues relevant to public health. Find more information and access the fact sheets.

Top Stories

National: EPA to reveal tougher sulfur emissions rule
Boston Globe   (03/03/2014)   Coral Davenport

On March 3, 2014, the U.S. Environmental Protection Agency (EPA) released stricter fuel and car standards. The new regulations require oil refiners to strip sulfur from American gasoline blends.

Sulfur, when burned in gasoline, blocks pollution-control equipment in vehicle engines. This blockage, in turn, increases tailpipe emissions linked to lung disease, asthma, emphysema, aggravated heart disease, chronic bronchitis, and premature births and deaths.

Oil refiners insist the changes will cost their industry $10 billion because the refiners will be required to install specialized equipment to remove the sulfur from the fuel. The refiners also say the changes will increase gasoline prices by up to nine cents per gallon.

The EPA projects the new rules will raise the price of gasoline by about two-thirds of one cent per gallon and add about $75 to automobile prices. The agency also estimates dramatic reductions in smog and soot and, therefore, diseases related to those pollutants.

EPA’s studies conclude that annually the new rule will prevent between 770 and 2,000 premature deaths; 19,000 asthma attacks; 30,000 cases of respiratory symptoms in children; 2,200 hospital admissions, and 1.4 million lost school and work days. By 2030, the EPA expects the changes will add up to between $6.7 and $19 billion in economic benefits.

“There is no other regulatory strategy that is as important from a health standpoint, in the foreseeable future,” said S. William Becker, director of the National Association of Clean Air Agencies.

[Editor’s note: Find more information and read the U.S. Environmental Protection Agency’s statement about the cleaner fuel and car standards.]

National: Healthy school lunch standards don’t waste vegetables
Boston Globe   (03/04/2014)   Deborah Kotz

The U.S. Department of Agriculture updated school lunch and breakfast requirements at the beginning of the 2012 school year. Under the new requirements, children must take at least one vegetable or fruit serving with their lunch. Many critics of the new requirements insisted that the requirements would end up in the trash, wasting money and effort. A new study by Harvard School of Public Health, recently published in the American Journal of Preventative Medicine, proved these detractors wrong.

The study measured the amount of waste food on the school lunch trays of more than 1,000 elementary schools before and after the new regulations implementation. The study found that in 2012, vegetable consumption increased by 16%. While fruit consumption remained the same in 2012 as it had been in 2011, the number of children who elected to have fruit with their lunch increased from 53%  to 76%.

“There was no increase in food waste. Kids were actually eating the fruit or vegetable they were selecting,” said Juliana Cohen, the research fellow at Harvard School of Public Health who lead the study.

[Editor’s note: Find more information about the U.S. Department of Agriculture’s school nutrition standards and the study, Impact of the New U.S. Department of Agriculture School Meal Standards on Food Selection Consumption and Waste [PDF - 157KB], published in the American Journal of Preventative Medicine.]

Briefly Noted

California: Bill to require primary care physician involvement for marijuana prescription
Medical marijuana bill limits who can prescribe pot
Orange County Register   (03/03/2014)   Laura Olson
[Editor’s note: Find more information and read California’s S.B. 1262 [PDF - 233KB].]

Florida: Tiny city’s overwhelming number of speeding tickets draws investigation
A dot on the map, after scandal, could be wiped off
New York Times   (03/10/2014)   Lizette Alvarez

New Mexico: Infants to be screened for critical congenital heart disease under new law
Governor signs tax break, screening, racino bills
Albuquerque Journal   (03/04/2014)   James Monteleone
[Editor’s note: Find more information and read New Mexico’s House Bill 9.]

Utah: Senate passes overdose reporting immunity bill
Bill to grant immunity for reporting drug overdoses gets final OK
Salt Lake Tribune   (02/21/2014)   Lee Davidson
[Editor’s note: Find more information and read Utah’s H.B. 11.]

National: FDA continues to review response to proposed menu labeling rules
FDA delays menu labeling changes until end of year
Law 360   (03/04/2014)   Kira Lerner
[Editor’s note: Find more information and read the U.S. Food and Drug Administration’s menu labeling rules.]

National: Bill would require Freedom of Information Act Requests to be managed online
House passes bill to put more FOIA processing online
Nextgov   (02/26/2014)   Joseph Marks
[Editor’s note: Find more information and read H.R. 1211 [PDF - 99KB].]

National: High-risk opioid abusers obtaining drugs by physician’s prescription
Report: Many high-risk opioid users get pills by prescription
Healthline   (03/03/2014)   Brian Krans
[Editor’s note: Find more information and read the study, High-Risk Use by Patients Prescribed Opioids for Pain and Its Role in Overdose Deaths, published in the Journal of the American Medical Association.

Yurok Tribe: Community-based wellness court offers justice and community healing
Tribal judge works for Yurok-style justice
Los Angeles Times   (03/05/2014)   Lee Romney
[Editor’s note: Wellness courts are a type of accountability-based court, similar to drug courts and child support courts, which focuses on making reparations and decreasing recidivism by rehabilitating the offender. Find more information about wellness courts and accountability-based courts and the Yurok Tribe and its justice system.]

Feature Profile in Public Health Law

Elizabeth L. Skillen, Ph.D.

Title: Acting Deputy Associate Director for Policy, Centers for Disease Control and Prevention

Education: B.S. in environmental health; M.S., entomology; Ph.D., ecology, University of Georgia

PHLN: Please describe your career path to your current position as CDC’s Deputy Associate Director for Policy (Acting).

Skillen: I came to CDC and public health in a round-about way—from field ecology. Whatever area I’m working in, my guiding principle is always to translate science into action. I have training in environmental health, entomology, and field ecology and consider myself a systems thinker. My focus in ecology was to understand how disturbance (e.g., fire and logging) impacts insect diversity, an indicator of ecosystem health. While policy at CDC may not seem like a logical career progression, if you think about it, the two areas have a good bit in common. Public health policy work requires evaluation of complex systems and like field work it can often be messy, a bit imperfect and rather unpredictable. CDC has provided me enormous opportunity to work with some of the most dedicated people in the world focused on a unified mission to improve the public’s health.

PHLN: Can you please describe your day-to-day job responsibilities?

Skillen: I have the privilege of working at CDC to advance the agency priority on public health and healthcare collaboration. I have served in this role for less than three months. The staff here is a group of sharp, talented folks, and it has been a delight to join the team! Day-to-day, I work to set strategic priorities, represent CDC with federal colleagues and other partners, support our office’s three directors and deputies to plan and execute the work of their units, provide mentorship to staff, and link related efforts in CDC Office of the Director offices and centers within the agency. In short, my role as a deputy is to keep the office functioning well. On occasion, I might even bake a pound cake to keep staff motivated and let them know how much we appreciate them! 

PHLN: What drew you from working as a field scientist and ecologist to public health policy?

Skillen: The mission of CDC was the most compelling reason for my switch from field science to public health and the opportunity to be a part of change strategies with enormous impact led me to policy. CDC is a science-driven agency filled with brilliant minds focused on making the world a healthier place.  My work in biodiversity and community ecology was fascinating and focused on understanding healthy forests. I spent many days in some of the most beautiful forests on Earth, like the Great Smoky Mountains National Park to name just one, but the opportunity to apply those science skills to improve health drew me to CDC. 

PHLN: How has your background and experience as a scientist supported your policy work?

Skillen: Science is about asking questions and collecting data to build an evidence base, all critical skills needed to evaluate and implement policy. My training helps me understand the expectation of rigor when working in a science-based agency like CDC. The bar is high at CDC and I think my training is an asset in helping me meet the bar. I am trained to seek out the critical questions and to look at the evidence that might help answer them and that is a perfect match for what I need to do in my policy work.

PHLN: Do you consider yourself a public health law practitioner? If so, in what ways is your job related to public health law?

Skillen: Yes—if my legal colleagues will claim me! Seriously, over the past several years, I have worked closely with PHLP and the Association of State and Territorial Health Officials (ASTHO) to assess state laws that promote patient safety. I mentioned that I am currently in an acting role, but in my home office I serve as the associate director for policy in the Division of Healthcare Quality Promotion and lead a team that conducts policy analysis to prevent healthcare-associated infections. I spent several years in partnership with ASTHO and PHLP evaluating state laws to understand best practices.

PHLN: How are public health law and epidemiology related?

Skillen: Epidemiology is the study of the pattern of disease and causes of death in populations, and public health law examines the authorities to improve the health of those very populations. So epidemiology identifies patterns and public health law is a powerful and important tool to improve the public’s health.

PHLN: How is public health law related to reducing healthcare-associated infections (HAIs)?

Skillen: The law and policies are clear levers to affect change in practice. Several federal initiatives are underway to advance HAI prevention. Further, state health agencies have a central role to play in HAI prevention because they are responsible for protection of patients across the healthcare system. HAI reporting represents the most robust component within existing state HAI statutes and has largely been driven by consumer demand for transparency and accountability. In 2004, only three states had public reporting mandates. That number has grown to 32 states in 2014. In addition, regulatory and oversight tools such as inspection requirements are significant levers for effective prevention of HAI and can be uniquely tailored in states.

PHLN: What do you find the most interesting or important aspects of CDC’s HAI policy efforts?

Skillen: Patient advocates’ dedication in championing patient safety and especially public reporting. They are largely responsible for driving transparency in the patient safety movement.   

PHLN: How do you foresee public health law shaping future CDC endeavors and missions?

Skillen: Policy will remain a critical tool for CDC to implement evidence based practices and improve health.

PHLN: Other than PHLP, what other CDC programs or centers have you partnered with to identify, evaluate, and promulgate sound evidence-based policies?

Skillen: I have worked with colleagues in the National Center for Emerging, Zoonotic and Infectious Diseases and the Center for Surveillance, Epidemiology, and Laboratory Services on the HAI evaluation work mentioned above. My current office supports the policy network within CDC that develops, translates, and shares evidence showing the health, economic, and budgetary impact of policy interventions.

PHLN: What have you found to be the most challenging aspects of public health policy and law?

Skillen: We strive to accelerate the adoption of CDC evidence-based practices and guidelines through rigorous policy evaluation. The greatest challenge of providing the most compelling evidence for policy options is definitely striking the balance between fact finding and timeliness for implementation. Policy approaches are only relevant if there are vehicles to drive action. For example, assessing emerging state law for application to federal levers, might require educating congressional staffers or aligning with rulemaking agendas to be salient. Timing is key, so sometimes we have to use the evidence, expert experience, and judgment that we learn from the field.

PHLN: What are your current projects?

Skillen: I am supporting an evaluation fellow in leading an assessment of state health department access to electronic health records data. This study is in response to recognized gaps in access during the 2012 fungal meningitis outbreak.

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

Skillen: Teaching. I spent much of my graduate career teaching and mentoring students and loved every minute of it. I can’t rule out a career in cycling or tennis, but I think I missed my window, and those will remain hobbies that my husband and I share along with raising our delightful son and daughter.

PHLN: Have you read any good books lately?

Skillen: The Orphan Master’s Son by Adam Johnson. It is a reminder of the value of checks and balances in government and the strength of the human spirit. 

PHLN: As an entomologist do you have a favorite insect?

Skillen: Parasitic wasps in the genus Ichneumon. Some of the species are fantastically beautiful creatures with iridescent colors. I think the fascination is partly that I didn’t know they existed until I was in graduate school. This may be a dated analogy, but their life-cycles are a bit like the Aliens movies—except they burst out of caterpillars, not people. The natural world is quite extraordinary.

PHLN: Is there anything you would like to add?

Skillen: Thanks for the opportunity to talk with you!

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 July 2014 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: Marche 2014

What is March 2014 Profile in Public Health Law Interviewee Elizabeth L. Skillen’s favorite type of insect?

Public Health Law News Quiz Question May 2014 Winner!

Dawn Hunter

Title: Public Health Law Fellow, Visiting Attorney Program of the Robert Wood Johnson Foundation; Office of Policy and Accountability, Office of General Counsel for the New Mexico Department of Health.

Response to the February 2014 Public Health Law News Quiz: Both Lindsay Wiley and Matthew Pierce have MPH degrees from Johns Hopkins Bloomberg School of Public Health. [Editor’s note: Both are also professors at American University Washington College of Law’s Health Law and Justice Program.]

Court Opinions

California: Cover charge at party with underage drinkers creates potential  liability
Ennabe v. Manosa [PDF - 277KB]
Supreme Court of California
Case No: S189577; Court of Appeals Number 2/1 B222784
Filed 2/24/14
Opinion by Judge Kathryn M Werdegar
[Editor’s note: Find more information about California’s law regarding liability associated with selling alcohol. California code section 25602.1, and the case by reading “California high court rules cover charge at parties creates liability,” published in the Los Angeles Times on February 24, 2014.]

Federal: Consent decree for new Food Safety Modernization Act regulations
Center for Food Safety v. Hamburg
United States District Court for the Northern District of California, Oakland Division
Case No: 12-cv-04529-PJH
Filed 02/25/2014
Consent Decree by Judge Phyllis J. Hamilton
[Editor’s note: Find more information and read the Food Safety Modernization Act.]

Federal: Plaintiffs must be assessed a penalty before challenging IRS
Halbig v. Sebelius [PDF - 208KB]
United States District Court for the District of Columbia
Case No: 13-0623 (PLF)
Filed 01/15/2014
Opinion by Judge Paul L. Friedman
[Editor’s note: Find more information about the case’s tax-related challenges to the Patient Protection and Affordable Care Act by reading “ObamaCare Through the Looking Glass: Judge Paul Friedman’s Opinion in Halbig v. Sebelius, Part 1,” published by Forbes, January 27, 2014.]

Federal: Expert’s opinion relevant to duty in radioactive uranium release case
McMunn v. Babcock, & Wilcox Power Generation Group, Inc.
United States District Court for the Western District of Pennsylvania
Case Nos: 2:10cv143, 2:10cv368, 2:10cv650, 2:10cv728, 2:10cv744, 2:10cv908, 2:11cv898, 2:11cv1381, 2:12cv1221, 2:12cv1459, 2:10cv1736
Filed 02/27/2014
Opinion by Judge David Stewart Cercone

Quotation of the Month

Troy Fletcher, Jr., Yurok Tribe member participating in the tribal Wellness Court

“I used to be afraid to go into court, afraid that they were going to take something from me. Here, they’re trying to give something back. I’ve got the whole tribe behind me,” says Troy Fletcher, Jr., a Yurok tribe member, of his experience participating in the Yurok Tribal Court’s Wellness Court. ”When I have to answer to my people, it makes me want to do better,” he adds. [Editor’s note: Wellness courts are a type of accountability-based court, similar to drug courts and child support courts, which focus on making reparations and decreasing recidivism by rehabilitating the offender. Find more information about wellness courts and accountability-based courts.]