Webinar About Community Health Needs Assessments and the Law: Best Practices for Complying with Federal Laws.external icon CDC’s Public Health Law Program (PHLP) will co-sponsor a webinar with the American Health Lawyers Association on community health needs assessments (CHNAs) and best practices for complying with federal laws. This is the first webinar in a three-part series called The Intersection of Public Health and Health Care: Emerging Trends in Health System Transformation and the Law. This webinar will provide a practical primer on implementing CHNAs as well as best practices for collaborating with health departments. The webinar also will provide case studies offering successful risk mitigation strategies for hospitals or health systems. This free webinar will take place May 23, 2018, from 2:00 pm to 3:30 pm (EDT) and will include a live question and answer session.
Job Opening: Chief Executive Officer, ChangeLab Solutions.external icon Since its founding in 1997, ChangeLab Solutions has worked to change public health practice from primarily focusing on patient education and clinical care delivery to using a dynamic and intersectoral approach to policy, systems, and environmental change. The organization is now seeking a new CEO who can advance national leadership that builds the field of law and policy in addressing the social determinants of health and creating equity. The new CEO will bring 1) a proven record of success in driving law and policy change to promote the social determinants of health, 2) nuanced understanding of health equity and the drivers that determine the health of communities, and 3) strong organizational leadership experience to lead ChangeLab Solutions into its next phase of work. Applications, including a cover letter describing your interest and qualifications and your resume (in Word format), should be sent to firstname.lastname@example.org.
Job Opening: The Network for Public Health Law, Northern Region.external icon The Network seeks a public health attorney to work in its Northern Region, based in Edina, Minnesota. This position will work closely with the Network’s Mid-States Region, located at the University of Michigan School of Public Health. The public health attorney will provide legal technical assistance, conduct trainings, develop tools and educational materials, and facilitate opportunities for networking and peer-assistance on a wide variety of public health law topics. Approximately one-half of the attorney’s effort will focus on legal issues related to sharing data to improve the health of communities. The attorney will develop particular areas of focus in at least two of the following: mental health and well-being, rural health, telehealth, oral health, climate resilience, and public health statutes and regulatory information. For best consideration, apply by May 24, 2018.
Learning from the Flint Water Crisis: Protecting the Public’s Health During a Financial Emergency. pdf icon[PDF – 683KB]external icon In January 2018, the de Beaumont Foundation, in partnership with the University of Michigan School of Public Health and The Network for Public Health Law, released a report that examines the complex legal arrangements that contributed to the Flint, Michigan, water crisis. The report analyzes the shortcomings in the structure and implementation of laws related to public health, safe drinking water, and emergency financial management, and explores why those laws failed to mitigate the crisis. The partnership produced a Public Health Handbook for Communities Under Emergency Management pdf icon[PDF – 256KB]external icon and an Emergency Manager Law Primer pdf icon[PDF – 955KB]external icon to improve legal preparedness and illustrate how state emergency laws intersect with public health laws.
First Disability Law Journal in the US.external icon The University of California Los Angeles Law School recently launched the first law journal in the country dedicated to disability law. The Disability Law Journal at UCLA “seeks to develop a discourse regarding disability law by publishing articles; editorials; and interviews of practitioners.”
Rural Communities Opioid Response funding opportunity. The Health Resources and Services Administration’s (HRSA’s) Federal Office of Rural Health Policy plans to award up to 75 grants to rural communities as part of a new Rural Communities Opioid Response (Planning) initiative in FY 18. Successful awardees will receive up to $200,000 for one year to develop plans to implement opioid use disorder prevention, treatment, and recovery interventions designed to reduce opioid overdoses among rural populations. The initiative will focus on the rural 220 counties identified by CDC as being most at risk pdf icon[PDF – 157KB]external icon, as well as other high-risk rural communities. The lead applicant must be part of a group including at least three other partners that have committed to forming a consortium or are part of an established consortium. All domestic public and private entities, nonprofit and for-profit, will be eligible to apply, and all services must be provided in rural communities. This initiative is part of a three-year Rural Communities Opioid Response initiative by HRSA aimed at supporting treatment for and prevention of substance use disorder. Please watch www.hrsa.govexternal icon and www.grants.govexternal icon for the notice of funding opportunity anticipated later in spring 2018. For more information, please email HRSA’s Allison Hutchings.
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 these methods may be applied to research and practice.
The Tribal Legal Preparedness Project.external icon Public health emergencies are issues that every community faces. Therefore, it is critical for all jurisdictions to understand how law can be used to enhance public health preparedness as well as improve coordination and collaboration across jurisdictions. As sovereign entities, tribal governments have the authority to create their own laws and take steps to prepare for and respond to public health emergencies. The Tribal Legal Preparedness Project was established to assist tribal nations interested in expanding their legal preparedness capacity.
Tool to Understand How Tax Exempt Hospitals Commit Community Benefit Expenditures.external icon The interactive Community Benefit Insight tool, funded by the Robert Wood Johnson Foundation in partnership with RTI International and the Public Health Institute, draws on IRS and other data to show how hospitals spend their community benefits dollars. The Community Benefit Insight tool allows users to compare different types of spending across hospitals and health systems.
City Rights in an Era of Preemption: A State-by-State Analysis. pdf icon[PDF – 3.21MB]external icon The National League of Cities (NLC) has published the 2018 update to its state-by-state analysis of preemption laws. The report is the third project outcome between NLC and the state municipal leagues. This study of state preemption began with collecting preemption data for each policy area from secondary sources. State municipal leagues then verified the data for their states to ensure timeliness and accuracy. A total of 38 state leagues responded to NLC’s requests for comment. This is the second edition of the report. Data are current as of February 2018.
Hawaii: Gov. Ige signs presidential disaster declaration requestexternal icon
According to Hawaii County Civil Defense, a volcanic eruption in and around Leilani, Hawaii had covered nearly 120 acres with lava and destroyed 36 buildings, forcing 217 people to shelter at the Pahoa Community Center, as of May 10, 2018. Nearly 100 others were sheltering elsewhere or seeking shelter. In addition to the threat of lava, Hawaii Island residents are also concerned about toxic gas released by open fissures.
Since the eruption began on April 30, the state and county have worked tirelessly to protect life and property from the encroaching lava flows. These efforts, which have cost the state and county more than $400,000 in emergency funding already, are anticipated to cost more than $2.9 million dollars within the next month, not including post-emergency repairs. These costs could become even more extreme if residents are forced to evacuate by sea.
On May 10, 2018, Governor David Ige signed a presidential disaster declaration, formally asking President Trump to declare the State of Hawaii a “major disaster.” Such a declaration would give Hawaii access to additional federal funding and support.
[Editor’s note: Read Hawaii Governor David Ige’s Presidential Disaster Declaration Requestexternal icon and read Governor Ige’s Lava Emergency Proclamation pdf icon[PDF – 331KB]external icon, which authorized expenditure of state monies as appropriated for quick and efficient volcanic eruption relief. Also access lava flow-related information for Hawaii Countyexternal icon.]
National: Reversing an overdose isn’t complicated, but getting the antidote can beexternal icon
NPR (05/07/2018) Jake Harper
Opioid overdoses can frequently be reversed with drugs such as naloxone (often sold under the names Narcan or Evzio). In the face of the ongoing national opioid crisis, in March 2018 US Surgeon General Jerome Adams issued the first Surgeon General’s advisory since 2005. The new advisory urges more laypeople to carry and know how to use naloxone. Naloxone is, however, a prescription drug, usually available only to medical professionals who are prescribing it directly for the person who is overdosing.
Corey Davis, an attorney with the National Health Law Program who studies public health laws related to the opioid epidemic, says these prescribing practices are another barrier to receiving care. “A lot of people at risk of an overdose don’t have contact with a medical provider or they’re afraid because of stigma,” Davis says. States have adopted several legal mechanisms to remove these barriers and save lives.
Every state and Washington, DC, have passed laws allowing laypeople, such as friends and family or bystanders, to obtain naloxone. Many states have passed third-party prescribing laws, which allow prescriptions to be written to someone who knows another person who may overdose. To further remove perceived or actual legal barriers in a crisis, many of these laws have been enacted in conjunction with Good Samaritan laws that provide immunity for those administering naloxone or calling 9-1-1 in an emergency.
Even with the removal of various barriers, many factors, such as the doctor or even the pharmacy, contribute to whether individuals who are not medical professionals may actually obtain the drug.
For example, Indiana’s then-health commissioner, Jerome Adams, signed a statewide standing order to allow nonprofits, pharmacies, and local health departments to register with the state and dispense the drug to anyone who requested it. Two years after the program was founded, only about 50 percent of pharmacies in the state are registered and many people, including some pharmacists, are still unaware of the law.
A researcher at Indiana University’s School of Public and Environmental Affairs, Brad Ray, says the problem is also compounded by the price of the drug, which can be about $80 for the generic and $95 for a name brand. “Getting it in the hands of users—that’s the trick we need to figure out,” says Ray.
Iowa: He lied about who he was. She agreed to have sex blindfolded. That doesn’t count as consent, rules Iowa’s Supreme Court.external icon
Des Moines Register (05/04/2018) Stephen Gruber-Miller
[Editor’s note: Read the Supreme Court of Iowa’s opinion in Iowa v. Kelso-Christyexternal icon, Case no. 16-0134, May 4, 2018. Learn more about sexual violence definitions.]
Kentucky: Kentucky Attorney General files fifth lawsuit against opioid manufacturersexternal icon
NBC 10 News (04/18/2018) WBIR
Puerto Rico: Puerto Rico to rebuild power grid using US national standardexternal icon
The Washington Post (05/07/2018) Danica Coto
Virginia: Virginia’s new 9-1-1 law has origins in high school classroomexternal icon
Route Fifty (04/22/2018) Michael Grass
[Editor’s note: Read Virginia’s SB 418 Public safety answering points; deployment of text-to-9-1-1external icon.]
Washington: Washington nurse arrested for infecting patients with hepatitis C, police sayexternal icon
Fox News (05/07/2018) Kaitlyn Schallhorn
[Editor’s note: Learn more about the risks of healthcare-associated infections from drug diversion.]
National: House farm bill would preempt local pesticide regulationsexternal icon
Route Fifty (04/20/2018) Bill Lucia
National: How many calories are in that pizza? Chain restaurants now have to tell youexternal icon
The Washington Post (0/07/2018) Caitlin Dewey
[Editor’s note: Learn more about FDA’s menu and vending machines labeling requirementsexternal icon.]
National: Organ transplants involving overdose-death donors increasingexternal icon
Renal and Urology News (04/18/2018) Jody A. Charnow
National: Took an ancestry DNA test? You might be a ‘genetic informant’ unleashing secrets about your relativesexternal icon
USAToday (04/27/2018) Ashley May
Greece: Volunteers who rescued migrants are cleared of criminal charges in Greeceexternal icon
New York Times (05/07/2018) Niki Kitsantonis
Venezuela: AIDS runs rampant in Venezuela, putting an ancient culture at riskexternal icon
New York Times (05/07/2018) Kirk Semple
World: When a mystery outbreak strikes, who you gonna call?external icon
NPR (05/04/2018) Jason Beaumien
[Editor’s note: Learn more about how to request Epi-Aids from CDC.]
Title: Administrator of Environmental Health Services, Shelby County Health Department, Shelby County, Tennessee
Education: DrPH, The University of Texas Health Science Center at Houston School of Public Health; MPH, The University of Texas Health Science Center at Houston
Public Health Law News (PHLN):Please describe your career path and what drew you to environmental public health.
Zerwekh::Once I realized I was never going to be a professional soccer player, I wanted to pursue something in health care. Both parents are in health care and I knew of nothing else that was discussed at the dinner table growing up!
PHLN:Please describe your health department and the community it serves.
Zerwekh:Shelby County Health Department (SCHD) oversees all public health responsibilities for the entire county, including the City of Memphis, seven municipalities, and unincorporated areas. A unique municipality with almost 950,000 residents, it sits on the Mississippi River and is a rare city accessible immediately by two other states.
PHLN:Will you please describe your position and day-to-day responsibilities?
Zerwekh:As the administrator of Environmental Health Services, I oversee the planning, operation, and response activities related to environmental public health concerns. There are three sections in the SCHD Environmental Health Services Bureau: Food Safety, Pollution Control, and Vector Control. Food Safety addresses sanitation and hygiene of facilities under the FDA Food Code. Pollution Control consists of air pollution and groundwater protection. Vector Control has three programs in it: mosquito control, urban/rural sanitation, and rabies control.
PHLN:Shelby County has a long history of mosquito-borne illnesses. Can you briefly describe that history?
Zerwekh:Situated on the banks of the Mississippi River, the Memphis delta has experienced mosquito-borne diseases and epidemics throughout its settlement history. Between 1828 and 1879, Memphis experienced six different yellow fever outbreaks—none more infamous than the 1878 outbreak. Introduced by a barge deckhand from New Orleans, the yellow fever virus swept through the City of Memphis, population 47,000 at the time, with an estimated 17,000 cases and more than 5,000 confirmed deaths. It crippled the city’s infrastructure. Additionally, the City of Memphis has battled West Nile virus (WNV), first introduced in 2001. Since 2001, 231 cases and 22 deaths from WNV have occurred in Shelby County.
PHLN:How are mosquito control programs normally funded?
Zerwekh:Traditionally, mosquito program funding can be broken down into three distinct tracks: 1) given to the health department and through jurisdictional general services funding, 2) funded jurisdictionally through a mosquito control district, or 3) special funding/grants to a recipient organization. NACCHO has performed surveys on this topic, and recent finding are summarized in Mosquito Control Capabilities in the U.S. pdf icon[PDF – 2.21MB]external icon
PHLN:Will you please describe how Shelby County funds its mosquito control program?
Zerwekh:Given the history of mosquito-borne outbreaks in Memphis, ever-shrinking funding for mosquito operations, and an increased interest in mosquito control after the arrival of West Nile virus, SCHD funds its mosquito program entirely through a special revenue fee solely used for mosquito control and urban/rural sanitation operations. This fee is called the Vector Control Fee and is put on every utility rate payer’s bill every month. The cost is $0.75 per month, or $9.00 a year. Depending on fluctuations in the number of rate payers, SCHD receives approximately $3.2 million to $3.6 million per year for mosquito control operations.
PHLN:How did your jurisdiction determine that a vector control fee attached to Memphis Light, Gas and Water Division servicesexternal icon was the best option for your jurisdiction? Were other funding mechanisms considered? If so, why were they unsuitable?
Zerwekh:Because of the history of mosquito-borne disease epidemics in Memphis, combined with dwindling local funding for mosquito control operations, the determination was solicited and accepted by local legislators to seek funding solutions. Processes that were entertained and discussed included using a flat nominal fee for all taxpaying citizens, as well as a voluntary “opt in” program. While each process had its benefits, it was determined that the logistics and execution of these options would not be conducive to mosquito control operations. SCHD needed to work with a recipient of regular funding (billing), which would serve as the clearinghouse for targeted monies. The utility company became that clearinghouse. It collects all the fees and remits an annual one-time payment every year.
PHLN:How did the department of health work to gain community buy-in for the Vector Control Fee?
Zerwekh:Similar to how a public health department works to gain public health accreditation, SCHD used a community health assessment to gather data and solicit input about community concerns regarding mosquitoes, mosquito reduction, and disease prevention. SCHD identified certain “hot zones” where past surveillance had indicated an elevated mosquito burden as well as confirmed West Nile virus human cases. Over the course of five or six meetings throughout these hot zones as well as another three or four throughout the county, SCHD used community input to assist in formulating the need for funding for vector control services while ascertaining what the community would pay for these services. Amounts as high as $50 a year and as low at $5 a year were entertained and discussed with the community. SCHD believed obtaining community stakeholder buy-in would help the department get legislator support to approve this funding mechanism.
PHLN:Were any stakeholder groups particularly challenging? If so, how did you overcome their concerns?
Zerwekh:One stakeholder group SCHD identified was private pest control companies in Memphis. Long a staple of private industry, these companies feared that SCHD was stealing their business. SCHD alleviated their reservations by reassuring the companies their personal home operations would not be impacted. Under EPA’s National Pesticide Discharge Elimination System permit, SCHD would only be able to apply adulticide (chemicals that kill adult mosquitoes) to thoroughfares and streets, not individual properties. Private pest control companies’ primary objective is to assess the client’s yard and items on the premises. Knowing SCHD could not make “house calls,” the companies did not object to the fee. As a sidenote, SCHD has entered into agreements with private pest control operators to use them in acute, epidemic outbreaks of mosquitoes to better treat private properties.
PHLN:What does the Vector Control Fee fund?
Zerwekh:The Vector Control Fee solely funds all mosquito control operations as well as urban/rural sanitation and rat control. For mosquito control, the fee allows the program to execute an integrated pest management program. SCHD Vector Control has identified thousands of locations that are prone to standing water (ditches, creeks, etc.). These locations are treated for mosquito larvae year round. The fee also funds the adulticiding program. SCHD Vector Control will truck spray with ultra-low volume equipment when certain vector mosquito thresholds are met. Year-round surveillance is also performed, using traps throughout the county, as well as typing the mosquitoes and monitoring to determine when nuisance mosquitos become vectors. Laboratory analyses are performed on the mosquitoes to detect presence of WNV. The program also provides enforcement activities in door-to-door inspections and citations for standing water or mosquito-breeding items in public and private domiciles. Vector Control also performs outreach and education, connecting thousands of community members a year with tips and information on reducing the mosquito burden.
Finally, the fee allows the program to respond immediately and proactively to emerging threats such as Zika and chikungunya.
PHLN:Funding through the Vector Control Fee began in 2005. What kind of results have you observed?
Zerwekh:I think a table would demonstrate the effectiveness of the Vector Control Fee:
|Year||No. of WNV Cases in Shelby County||No. of WNV Deaths in Shelby County|
|2005 (Vector Control Fee instituted)||13||0|
As you can see, from 2002 to 2004, Shelby County experienced 100 WNV cases and 10 deaths. From 2005—the year the Vector Control Fee was instituted—to present, there have been 88 cases with 5 deaths. In other words, over the past 13 years, Shelby County has not even reached the number of cases and deaths that we saw in just the three years prior to implementation of the fee. A basic chi-square contingency table statistically supports the notion of a protective public health benefit from the Vector Control Fee.
PHLN:What were the greatest challenges in creating the new funding mechanism for vector control?
Zerwekh:One of the biggest challenges was deciding on a fee amount that would be enough to provide quality service without being too taxing to community stakeholders. Fortunately, this challenge was lessened with our community meetings and open forums to better gauge the community’s investment in the program. Another challenge was gaining support from the private pest control companies. Fortunately, once they were educated on our operations, they welcomed the Vector Control Fee.
PHLN:What advice do you have for other jurisdictions interested in creating their own vector control fee?
Zerwekh:That’s a great question! If anything, I hope this discussion generates opportunities for health departments looking to provide sustained and funded mosquito control operations. Our public health system is always so responsive—we throw a bunch of money at an emerging/acute issue (see: chikungunya, Zika, Ebola, opioids), but then when the threat subsides for just a moment, the issue goes off the radar, never to be funded again. Look at the funding stream for public health emergency preparedness.
Given that, the advice I have for jurisdictions is to not let the “concern” over the threat wane vainly. When you have a bad mosquito-borne disease season, or your jurisdiction encounters an emerging threat, the time is NOW to engage the community and your legislators to explore options for sustained funding to address these issues. Without the yellow fever history in Memphis, West Nile virus in the city at the turn of the century would have perhaps just been another faded health concern highlighted by the media.
PHLN:Have you read any good books lately?
Zerwekh:I tend to fall back more on the biographies/autobiographies genre, so I just finished Keith Richards’ “Life”—a great analysis of what it takes to be on the road for the greatest classic rock and roll band still performing. Absent that, I like Hunter S. Thompson, Graham Greene, and Kurt Vonnegut.
PHLN:What would you be doing if you weren’t working in environmental public health?
Zerwekh:Ideally playing soccer professionally! Also, I’ve always been entertained by the fine arts and was in theater in high school, so I guess perhaps something in the arts and entertainment field.
PHLN:Do you have any hobbies?
Zerwekh:With eight- and six-year-old daughters, my hobbies are to not corrupt them! Actually, when I get the free time, I love to play golf. I also love to travel, and I like cooking (from recipes) nice meals.
The first reader to correctly answer the quiz question will be featured in a mini public health law profile in the June 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 May 2018
Which resource in the May 2018 edition of the Public Health Law News was established to assist tribal nations interested in expanding their legal preparedness capacity?
When does the application period close for the notice of funding opportunity, CDC-RFA-OT18-1803: Tribal Public Health Capacity Building and Quality Improvement Umbrella Cooperative Agreement, announced by CDC’s Office for State, Tribal, Local and Territorial Support?
Winning Quiz Answer: April 24, 2018 by 11:59 pm EDT
Employment organization and job title:
Arizona Health Care Cost Containment System (AHCCCS)—Manager, Clinical Administration
A brief explanation of your job:
I manage clinical and nonclinical staff within the prior authorization and utilization review areas of Arizona’s Medicaid agency. I also serve as a subject matter expert for policy development and as a member of various other agency committees.
Education: Currently finishing my BSN
Favorite section of CDC’s Public Health Law News:Tribal Law
Why are you interested in public health law? The public health law information provided often relates either directly or indirectly to my job functions in public health. It lends context to current issues in public health that may or may not be evident within my work environment, and supports my effort to ensure I have credible knowledge to help inform the decisions I make in practice. This information supports my effort to further AHCCCS’s mission.
What is your favorite hobby? My favorite hobbies are spending time with my grandchildren, reading, and playing with my dog and cat.
California: State’s fluoridation law preempts San Diego municipal code prohibiting the addition of fluoride to the city’s water supply.
Kennedy v. City of San Diegoexternal icon
Court of Appeals of California, Fourth District, Division One
Case No. D072337
Opinion by Justice Judith L. Haller
New York: Summary judgment denied to defendant doctor accused of negligently prescribing opioids. Defendant failed to provide evidence of accepted medical practice or how his actions fell within the bounds of accepted medical practice.
Halloran v. Kiriexternal icon
Supreme Court, Bronx County, New York
Case No. 21037/2015E
Opinion by Judge Mary Ann Brigantti
West Virginia: State reaches settlement agreement for $550,000 with pharmacy accused of dispensing almost 10 million doses of opioids over an eleven-year period in a single county that had fewer than 25,000 residents.
West Virginia v. Larry’s Drive-In Pharmacy Complaint pdf icon[PDF – 8.83MB]external icon
Complaint filed 12/07/2016
Settlement Agreement and Release of All Claims [PDF – 3.92MB]external icon
Eric Pevzner, PhD, MPH (Captain, USPHS), Branch Chief of the Epidemiology Workforce Branch, Chief of the Epidemic Intelligence Service Program, CDC
“There’s definitely no shortage of work for us. Many local health departments don’t have the resources to prevent illnesses like cardiovascular disease, diabetes and cancers that are a major public health burden in the United States. And then we have things like the emerging threats. We had Ebola in West Africa. We had Zika in many parts of the world. And so it’s the constant challenge of being able to focus on the ongoing public health challenges we face and the emerging threats,” said Pevzner. [Editor’s note: This quote is from When A Mystery Outbreak Strikes, Who You Gonna Call?external icon, NPR, 05/04/2018.]
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.
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.