March 2018

Announcements

Webinar About Careers in Health Law: A Look at Government.external icon PHLP will co-sponsor the final webinar in a four-part webinar series with the American Bar Association’s Government Sector Task Force. This webinar will provide information about health law career opportunities in government. Speakers from this field will highlight their personal experiences and how to successfully navigate a career within the government. This free webinar will take place on March 20, 2018, 1:00–2:00 pm (EDT).


Notice of Funding Opportunity: Technical Assistance for Response to Public Health or Healthcare Crises.external icon CDC’s Office for State, Tribal, Local and Territorial Support is pleased to announce that CDC-RFA-OT18-1804, Technical Assistance for Response to Public Health or Healthcare Crises, has been published on Grants.gov. The purposes of this notice of funding opportunity are to 1) establish a pool of organizations capable of rapidly providing essential expertise to various parties involved in an emergency response and 2) fund select awardees to provide that support, when required, based on CDC’s determination of need. Applications are due no later than 11:59 pm (EDT) on March 16, 2018.


Notice of Funding Opportunity: Strengthening Public Health Systems and Services through National Partnerships to Improve and Protect the Nation’s Health.external icon CDC’s Office for State, Tribal, Local and Territorial Support is pleased to announce that CDC-RFA-OT18-1802, Strengthening Public Health Systems and Services through National Partnerships to Improve and Protect the Nation’s Health, has been published on Grants.gov. The purpose of the funding opportunity is to: 1) strengthen the nation’s public health infrastructure; 2) ensure a competent, current, and connected public health system; and 3) improve the delivery of essential public health services through capacity-building assistance. Applications are due no later than 11:59 pm (EDT) on March 29, 2018.


Notice of Funding Opportunity: Tribal Public Health Capacity Building and Quality Improvement Umbrella Cooperative Agreement.external icon CDC’s Office for State, Tribal, Local and Territorial Support (OSTLTS) is pleased to announce that a new notice of funding opportunity (NOFO), CDC-RFA-OT18-1803: Tribal Public Health Capacity Building and Quality Improvement Umbrella Cooperative Agreement, has been published on Grants.gov. This new five-year cooperative agreement will fund up to 25 federally recognized American Indian and Alaska Native (AI/AN) tribal nations and regional AI/AN tribally designated organizations to optimize the quality and performance of the tribal public health systems, including infrastructure, workforce, data and information systems, programs and services, resources and communication, and partnerships. Applications are due no later than 11:59 pm (EDT) on April 24, 2018. For more information, please send questions to OSTLTSTribalNOFO@CDC.gov.


Training Opportunity: Tribal Action Plan Development Workshop—A Tribal Law and Order Act Training Initiative. The Tribal Action Plan (TAP) Training Initiative was established in direct response to the Tribal Law and Order Act of 2010. TAP supports the principle of tribal self-determination and provides tribes the opportunity to take a proactive role in the fight against alcohol and substance misuse in tribal communities. To nominate a tribe for the TAP workshop, email Delores McCarter at delores.mccarter@usdoj.gov. Nominations due by March 16, 2018.


Policy Surveillance Summer Institute 2018.external icon Temple University’s Policy Surveillance Program will host the third annual Policy Surveillance Summer Institute June 7–8, 2018, in Philadelphia, Pennsylvania. The institute is open to students and professionals interested in policy surveillance. Attendees will learn introductory and advanced policy surveillance methods and how they could be applied to research and practice.

Legal Tools

Menu of State Healthcare Facility Measles, Mumps and Rubella (MMR) Vaccination Laws. Many states require healthcare workers or patients to be vaccinated for MMR. This menu, published by CDC’s Public Health Law Program (PHLP), describes the different requirements for facilities, patients, and healthcare providers. PHLP’s vaccinationexternal icon page offers information about additional healthcare worker and patient vaccinations for hepatitis B, flu, pertussis, pneumococcal disease, and varicella.


Online Introduction to Legal Epidemiology. external iconLegal epidemiology provides a scientific approach to studying the impact and effectiveness of laws on health. This online training is part of the Public Health Law Academy, created by PHLP and ChangeLab. This training will explain how law affects health, enable participants to define and describe basic legal epidemiology principles, and apply legal epidemiology in practice.


Council to Improve Foodborne Outbreak Response (CIFOR) Law Project.external icon In 2013, CIFOR analyzed foodborne disease surveillance and investigation laws in select states. Tools created through this work include a public health practitioner handbook to implement foodborne disease surveillance and investigation laws and a menu of recommended laws that state and local public health officials and policy makers might consider. These tools help state and local public health agencies improve legal preparedness for foodborne disease detection and outbreak response.


Issue Brief about Opioids.external icon All for One and One for All: Developing Coordinated State Opioid Strategies summarizes the critical experiences of senior public officials as they work to address the opioid crises in their states and identifies the key ingredients in a coordinated state opioid strategy. This issue brief, produced in partnership with the Center for Evidence-based Policy at Oregon Health & Science University and written by health policy journalist Noam Levey, is based on interviews with more than two dozen current and former state officials in public health, Medicaid, law enforcement, corrections, and behavioral health.

Top Stories

Massachusetts: The not-an-opioid epidemicexternal icon
Proto Magazine (01/24/18) Timothy Gower

Story Highlights

The current opioid crises plaguing the United States has encouraged doctors to find alternative pain management prescription options for their patients. Gabapentinoids are among these alternative prescription drugs.

Gabapentinoids reduce acute pain in patients, they were not originally approved by the US Food and Drug Administration (FDA) for pain management. In fact, Neurotonin was approved as an anti-seizure medication and was later cleared for treating postherpetic neuralgia, a condition associated with nerve damage from shingles. Lyrica was another gabapentinoid created after Neurotonin and approved for the same uses. It was also approved to treat fibromyalgia and pain associated with nerve damage from diabetes.

Since the creation of these drugs, prescriptions for “off label” treatment have been increasing, meaning they are prescribed for conditions that were not included in the FDA approval. While legal and common, off label use means   FDA has not determined that the drug is safe and effective for that unapproved use.

Between 2012 and 2016, gabapentinoid prescriptions became the 10th most prescribed drug in the United States, representing a 64 percent increase in gabapentinoids. There is a lack of evidence, however, supporting the efficiency of these drugs in reducing common pains.

Dr. Harsha Shanthanna, an anesthesiologist at St. Joseph’s Healthcare at McMaster University, Ontario, Canada, says, “The precise mechanism of Gabapentinoids is unknown, though they can dampen pain signals sent to the brain by damaged nerves.” In addition to questions about the safety and efficacy of gabapentinoids in addressing pain, patients prescribed gabapentinoids are selling their pills illegally.

Supporters of the off label use of gabapentinoids hope they could find better alternatives than opioids, possibly leading to fewer addictions, injuries, and deaths.

Opponents of the drugs believe the lack of evidence supporting their ability to reduce chronic pain will lead patients into addiction, as well as put patients at risk of the side effects from using an ineffective drug. Thomas Sherba, the Ohio Substance Abuse Monitoring Network’s principal investigator, says, “[T]here have been reports of patients obtaining medications by doctor shopping and faking symptoms . . . combining opioid replacement with extra-large doses of gabapentin produces a heroin-high.”

While the long-term prognosis of using gabapentinoids for off label pain management is not yet clear, physicians and researchers are optimistic about other pain management alternatives to opioids. For example, some researchers are leaning towards the use of antidepressants and non-pharmacological interventions, such as exercise and cognitive behavioral therapy, as a solution to the opioid crisis. Dr. Shantanna says, “We need to do more for our patients and not just prescribe something indiscriminately that we think will work.”

[Editor’s note: Learn more about Understanding Unapproved Use of Approved Drugs “Off Label”external icon from FDA.]


Sweden: Consent in the digital age: can apps solve a very human problem?external icon
New York Times (03/02/18)    Maya Salam

Story Highlights

As technology becomes more closely intertwined with everyday life, developers and users are exploring tech-based responses to prevalent social issues. Recently, LegalFling created an app that allows users to give consent to sexual activity before an encounter. App developers made LegalFling in response to Sweden’s law requiring uninhibited verbal consent before participation in sexual activities. Critics are worried that spontaneity in relationships and the app’s inability to adjust automatically might lead to adverse effects or confusion.

LegalFling allows users to create customizable profiles of their intent with another party before a date. The updated data from individuals meeting each other stores as block data on the company’s mainframe. The updates are then immediately sent to both parties. LegalFling is not the first consent awareness application. In 2015, the Institute for the Study of Coherence and Emergence created “We-consent” for college students to help them adhere to the execution of affirmative consent rules.

Opponents of the app also worry about users’ ability to update the app within meaningful timeframes. They are concerned that when some people are under the influence of drugs or alcohol (or experience rapid emotional changes), they might not be able to use the app to successfully communicate sexual intent. Dr. Michelle Drouin says, “Use of the app has to be planned, and it is challenging for us even to know how we feel in the present moment, much less trying to anticipate how we might feel an hour from now.”

Supporters of the app believe its ability to capture an individual’s consent could provide evidence in any subsequent legal inquiries where there are questions about mutual consent.

While the app could be construed as evidence on a victim’s behalf, it could also potentially be used to protect an aggressor. Andrew D. Cherkasky, a former special victims’ prosecutor and current criminal defense attorney, cautions against making strict assumptions based on the information elucidated in the app. “It turns consent into a joke, a technicality that people think is black and white or can be recorded in a moment of time,” says Cherkasky.

Although controversial, application developers continue to make steps to address the issue of affirmative consent.

[Editor’s note: Learn more about intimate partner violence and sexual violence.]

In Focus: Opoids

Michigan: Overdose deaths fuel surge in organ donationsexternal icon
The Detroit News   (03/05/2018)   Karen Bouffard and Sarah Rahal


National: FDA to expand medication-assisted therapy for opioid addictsexternal icon
New York Times   (02/25/2018)   Sheila Kaplan
[Editor’s note: Learn more about FDA’s plan to reduce the impact of opioid misuse and abuseexternal icon.]


National: Study: More kids are ending up in ICUs because of opioidsexternal icon
The Inquirer   (03/04/2018)   Rita Giordano
[Editor’s note: Read Opioid-Related Critical Care Resource Use in US Children’s Hospitalsexternal icon. Jason M. Kane, Jeffrey D. Colvin, Allison H. Bartlett, Matt Hall. Pediatrics Mar 2018,  e20173335; DOI: 10.1542/peds.2017-3335]


National: Opioid deaths mounting, lawmakers hit gas on new legislative pushexternal icon
Doctor News   (02/26/2018)


National: Overview of State Litigation to Combat the Opioid Epidemicexternal icon
Association of State and Territorial Health Officials (02/22/2018)   ASTHO Staff

Briefly Noted

Georgia: Deal signs Georgia adoption overhaulexternal icon
The Atlanta Journal Constitution   (03/05/2018)   Mark Niesse
[Editor’s note: Read Georgia’s House Bill 159external icon.]


New York: Health officials fear an Australian tourist spread measles across New Yorkexternal icon
Washington Post   (02/25/2018)


Oregon: Oregon effort to declare healthcare a right faltersexternal icon
Corvallis Gazette-Times   (02/28/2018)   Andrew Selsky
[Editor’s note: Read Oregon’s Joint Resolution 203external icon.]


National: #MeToo movement fuels a 1970s comeback: The ERAexternal icon
Stateline   (03/01/2018)   Marsha Mercer
[Editor’s note: Learn more about the Equal Rights Amendmentexternal icon.]

Global Public Health Law

Canada: Tiny Canada town defeats oil firm in court fight over drinking waterexternal icon
The Guardian   (03/03/2018)   Ashifa Kassam


France: Two cases involving sex with 11-year-olds forced France to raise the age of consentexternal icon
The Washington Post   (03/06/2018)   Jason Rezaian


Thailand: ‘Baby factory’ mystery: Thailand’s surrogacy saga reaches an uneasy endexternal icon
BBC   (02/26/2018)   Johnathan Head


Europe: WHO warning as European measles rate jumps from record lowexternal icon
BBC News   (02/20/2018)
[Editor’s note: Read about measlesexternal icon on the World Health Organization’s website.]

Profile in Public Health Law: Cason Schmit, JD
Photo: Cason Schmit, JD

Title: Research assistant professor, Texas A&M University, Department of Health Policy and Management

Education: Arizona State University, Sandra Day O’Connor College of Law, JD


Public Health Law News (PHLN):Please describe your career path, what drew you to public health law and, more specifically, public health management and policy.

Schmit:Like many other first year law students, I couldn’t tell you what public health was. I only hoped to use my law degree to do “good,” whatever that meant. While at Arizona State, three professors in particular played undeniable roles in kindling three core professional passions: service, public health, and technology governance. After law school, I moved to DC and applied for every opportunity that I could find, eventually striking gold with a fellowship with CDC’s Public Health Law Program. There, I thrived under excellent mentors who cultivated my passions, curiosities, and methodologic rigor. In 2016, I joined the Texas A&M School of Public Health to continue my study of the impact of laws and to become the same type of mentor who inspired and motivated me as a graduate student.

PHLN:What is the Department of Health Policy and Management at the University of Texas A&M and what is your role there?

Schmit:I wear many hats at Texas A&M. My official title is research assistant professor, so my primary focus is research relating to law, policy, and ethics. However, I also teach several courses, including Health Law and Ethics, Health Systems Leadership, and our integrated MPH core curriculum. I am also the privacy officer for the School of Public Health.

PHLN:You recently published an article about health information exchange (HIE) in the Journal of the American Medical Informatics Association. Can you please explain HIE briefly?

Schmit:HIEs are organizations that facilitate the transfer of health information between entities. Although HIEs primarily function to transfer data for treatment purposes (i.e., between healthcare providers), many HIEs can also exchange data for many other purposes including public health, and research.

PHLN:How does HIE relate to law and public health outcomes?

Schmit:On a basic level, laws define the boundaries and exceptions to doctor-patient confidentiality. Since HIEs exist to facilitate sharing of this protected data, sometimes we need laws to define how HIEs can operate in this space. On another level, many states have decided to establish and operate a state-wide HIE. In that context, laws are necessary to define the authority of the HIE to operate and share data.

PHLN:Are you working on additional HIE-related research? If so, will you please describe your research?

Schmit:HIEs had been widely predicted to help drive down healthcare costs while improving efficiency. Unfortunately, the data do not show that all HIEs are achieving those goals. Moreover, some HIEs are struggling while others are more sustainable. The literature suggests that laws can play a significant role in supporting (or hindering) HIE use and sustainability, but the evidence base is fairly weak. My colleagues and I are actively exploring whether certain types of HIE laws are more effective than others in facilitating data exchange and HIE sustainability.

Photo: Cason Schmit, JD

PHLN:Can you explain or give an example of how the difference in the leniency of HIE regulation plays out in real life?

Schmit:The literature is full of recommendations for states to adapt various laws to support HIEs. The Indiana Health Information Exchange, however, has continued to operate successfully in a state without any HIE-specific laws. Given the weakness of the existing evidence, there is a plausible hypothesis that in fact fewer regulations might support HIE use. My colleagues will be testing this hypothesis using longitudinal legal data.

PHLN:What other data-sharing research are you currently pursuing?

Schmit:I’m working closely with Denise Chrysler of the Mid-states Region of the Network for Public Health Lawexternal icon to identify solutions for data sharing across sectors. We are examining the federal law framework for data protection in a variety of contexts, including social services, health plans, education, and veterans. A patchwork of federal laws makes it exceedingly difficult to share these data and use them for public health purposes.

PHLN:How might a better understanding of laws’ impact on data sharing improve public health response?

Schmit:There are legitimate reasons to both protect data and to free it for greater social benefit. I think the most important goal is to enact laws that function as they are intended (i.e., protect data or facilitate data sharing). It is often difficult, however, to know whether a law has unintended and undesirable consequences. By better understanding the types of laws that are associated with HIE use or data sharing, law makers will have more information about the types of laws that can meet the needs and desires of their constituents.

PHLN:How can individuals, public health managers, and policy makers learn more about data sharing and public health law?

Schmit:Webinars hosted by the Network for Public Health Lawexternal icon and CDC’s Public Health Law Program are great resources. Privacy and data sharing are tricky legal domains where it is easy to make incorrect assumptions based on incomplete knowledge. If your organization has an attorney, they can be great resources. As a privacy officer, we would much rather hear about issues relating to privacy or data sharing earlier rather than later!

PHLN:Have you read any good books lately?

Schmit:My wife and I are expecting our first child, so my nose is buried in “The Expectant Father.” I also recommend “Weapons of Math Destruction,” which takes a close look at how big data analytics can be misused to unfairly and disproportionally affect individuals and communities.

PHLN:What would you be doing if you weren’t working in public health policy?

Schmit:I would probably work in computer programming. I love problem solving and building things I can use.

PHLN:Do you have any hobbies?

Schmit:I love brewing beer, and always try to have a homebrew on tap. My next beer is an imperial IPA.

[Editor’s note: Read about health information exchanges- Cason D Schmit, Sarah A Wetter, Bita A Kash; Falling short: how state laws can address health information exchange barriers and enablersexternal icon, Journal of the American Medical Informatics Association, ocx122.]

Public Health Law NewsQuiz

The first reader to correctly answer the quiz question will be featured in a mini public health law profile in the March 2018 edition of the News. Email your entry 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 March 2018

Which public health law organization is hosting the Policy Surveillance Summer Institute 2018 in Philadelphia, Pennsylvania?

Public Health Law NewsQuiz Question February 2018 Winner!
Photo: Elena Ochoa

Elena Ochoa

February Question: When are applications due for the OSTLTS Notice of Funding Opportunity: Technical Assistance for Response to Public Health or Healthcare Crises?

Winning Quiz Answer: No later than 11:59 pm (ET) on March 16, 2018.

Employment organization and job title: Department of Health and Mental Hygiene/Department of Education, Manager and coordinator for the Afterschool/Extended Day Programs.

A brief explanation of your job: I manage the approval of afterschool and extended day programs for all of New York City schools. This entails receiving request from schools, processing said requests, determine approval based on rules set by Public Employment Relations Board (PERB), post request in order for nurses to apply, and communicate all aspects of the process to all parties involved.

Education: MPA, Health Administration.

Favorite section of the News:  Health Law and News.

Why are you interested in public health law? It is very important for me because it provides the most up to date laws and regulations news on health issues in a brief  graphically and explanatory manner. It describes a topic step by step of what is the subject about.

What is your favorite hobby?  Dancing, as an exercise to keep my body healthy and in shape.

Court Opinions

Colorado: Obtaining food stamps by fraudulent act can be penalized only by the Colorado Public Assistance Act’s specific penalty statute.
People of the State of Colorado v. Rojasexternal icon
Court of Appeals of Colorado, Division I
Case No. 15CA0126
Filed 02/22/2018
Opinion by Judge David Furman


New Jersey: First published case discussing state’s Overdose Prevention Act (OPA). The case was remanded by appellate court for full evidentiary hearing to determine whether the initial report that defendant was “intoxicated, and which led to the defendant receiving police and medical treatment, falls under the OPA’s definition of “overdose.”
State of New Jersey v. WSBexternal icon
Superior Court of New Jersey, Appellate Division
Case No. A-5569-16T1
Decided 02/26/2018
Opinion by Judge Ja-0’/ck M. Sabatino


New York: State’s public health law provides a cause of action for injury to patients in residential healthcare facilities when those injuries are caused by the deprivation of a right. Immediate case for partial summary judgment dismissed because defendant has asserted triable issues of fact regarding its exercise of “all care reasonably necessary . . . .”
Cornell v. County of Monroeexternal icon
Appellate Division of the Supreme Court of New York, Fourth Department
Case No. 1372 CA 17-00675
Decided 02/02/2018
Unanimous Opinion

Quote of the Month

Dr. Harsha Shanthanna, an anesthesiologist at St. Joseph’s Healthcare at McMaster University in Ontario, Canada

“We need to do more for our patients and not just prescribe something indiscriminately that we think will work,” said Dr. Harsha Shanthanna of alternative prescriptions for pain management. [Editor’s note: This quote is from The Not-an-Opioid Epidemicexternal icon, Proto, 01/24/2018]

The Public Health Law Newsis 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 Newsis published by the Public Health Law Program in the Center for State, Tribal, Local, and Territorial Support.

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Disclaimers

Public Health Law News (the News) content is selected solely on the basis of newsworthiness and potential interest to readers. CDC and HHS assume no responsibility for the factual accuracy of the items presented from other sources. The selection, omission, or content of items does not imply any endorsement or other position taken by CDC or HHS. Opinions expressed by the original authors of items included in the News, persons quoted therein, or persons interviewed for the News are strictly their own and are in no way meant to represent the opinion or views of CDC or HHS. References to products, trade names, publications, news sources, and non-CDC websites are provided solely for informational purposes and do not imply endorsement by CDC or HHS. Legal cases are presented for educational purposes only, and are not meant to represent the current state of the law. The findings and conclusions reported in this document are those of the author(s) and do not necessarily represent the views of CDC or HHS. The News is in the public domain and may be freely forwarded and reproduced without permission. The original news sources and the Public Health Law News should be cited as sources. Readers should contact the cited news sources for the full text of the articles.

Page last reviewed: March 15, 2018