December 2018

Letter from the Editor

The Public Health Law Program (PHLP) would like to thank Mashal Mirza for her assistance in writing the September, October, November, and December 2018 editions of Public Health Law News.Ms. Mirza interned with PHLP while pursuing her master of public health degree from Emory University’s Rollins School of Public Health. She is expected to graduate May 2019 and will be an asset to the public health field.

PHLP would also like to thank the following law interns for their assistance researching cases for the October and November editions of the News:

  • Carlos Quijada, MPH, JD candidate, ’19, S.J. Quinney College of Law, University of Utah
  • Lauren Wallace, MPH, JD candidate, ’19, University of Georgia School of Law

We hold these interns in deepest regard and wish all of our interns every success in their future endeavors.

F. Abigail Ferrell, JD, MPA

Editor in Chief


CDC Externships in Public Health Law. PHLP offers externships in public health law, tribal public health, and administration and communications. The externships consist of 9–14 weeks of professional work experience with PHLP in Atlanta, Georgia. With rolling start and completion dates during the academic year, unpaid externships must qualify for academic credit as authorized by law and public health schools. Applications for summer 2019 positions are due by January 31, 2019.

Healthy People 2030 Public Comment Period.external icon The US Department of Health and Human Services (HHS) is soliciting written comments regarding the Healthy People 2030 objectives. The public comment period will be open through January 17, 2019.

Call for Papers by Public Health Reports.Public Health Reportsseeks submissions for a special supplement report on policy approaches that work to lower the incidence, mortality, and morbidity of HIV, viral hepatitis, sexually transmitted diseases, and tuberculosis. This supplement is intended to share recent articles on effective policy interventions. Abstract submissions are due by midnight (EST) January 4, 2019.

Five-Part Webinar Series Exploring Policy Surveillance.external icon The Center for Public Health Law Research will host a five-part monthly webinar series examining policy surveillance and empirical legal research methods and standards, issues in global and local policy surveillance, and challenges and opportunities for the use of policy surveillance in research and policy making. The first webinar in the series will discuss policy surveillance methods and standards and will take place January 15, 2019, 1:00–2:00 pm (EST).

APPE 28th Annual Conference.external icon Registration is now open for the Association for Practical and Professional Ethics’ (APPE’s) 28th Annual Conference. This is an opportunity for individuals across all disciplines to learn about professional and practical ethics. The conference is
February 28–March 3, 2019. On-time registration ends February 1, 2019.

Vector Control Workshops.external icon The National Association of County and City Health Officials (NACCHO) is hosting a vector control workshop in Charleston, South Carolina, and Montgomery, Alabama, January 8–9, 2019, and January 15–16, 2019, respectively. These workshops will offer training in increasing the capacity of vector control programs in areas affected by Hurricanes Harvey, Irma, and Marie.

Grant Opportunity from OVW.external icon The US Justice Department’s Office on Violence Against Women (OVW) has announced a grant program for Indian tribes concerning domestic violence. The program encourages collaborative efforts among tribal leadership, courts, prosecutors, attorneys, defenders, law enforcement, probation, victim services providers, and other partners to ensure that victims find safety and justice. The program is also intended to ensure that non-Indians who commit crimes of domestic violence, dating violence, and violations of protection orders in tribal territory are held accountable. Application period closes February 14, 2019.

Legal Tools

CDC Releases 2018 Public Health Emergency Preparedness and Response Capabilities. CDC has published the 2018 Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health.CDC began updating the capabilities in 2017 in response to feedback from CDC subject matter experts, state and local health departments, and national partner organizations. The 2018 standards recognize the maturity and experience jurisdictional public health emergency preparedness and response programs have gained since 2011. They also describe the components necessary to advance jurisdictional public health preparedness and response capacity.

CDC Publishes 2016 Healthcare-Associated Infections Progress Report. CDC’s Healthcare-Associated Infections Progress Report details, on a national and state-by-state basis, data on healthcare-associated infections—infections that patients can contract during their time at a healthcare facility. This report also highlights progress and areas that need improvement.

Stroke Systems of Care Policy: Evidence Assessment Reports. On average, a stroke occurs every 40 seconds in the United States. Stroke systems of care improve patient care and support throughout the patient’s healthcare journey—from the first symptoms of stroke, EMS transport, and hospital care to follow-up with outpatient providers. State law could help scale up evidence-based interventions shown to increase the reach, consistency, and coordination of stroke care. Read recently released assessments of policy evidence to learn which 16 recommended stroke policy interventions are most effective.

Wildfire Health and Safety Information and Resources.external icon The National Association of County and City Health Officials (NACCHO) has published a collection of resources regarding wildfire health and safety. Legal and Non-Legal Strategies to Improve Childhood Lead Screening Rates in Illinois and Ohio.external icon The Network for Public Health Law has published an issue brief that examines the legal screening requirements in Illinois and Ohio. This brief includes information on state laws and Medicaid requirements. It also explores strategies to improve lead screening rates.

Top Stories

North Carolina: Anti-vaccination stronghold in N.C. hit with state’s worst chickenpox outbreak in 2 decadesexternal icon
The Washington Post   (11/19/2018)   Isaac Stanley-Becker

Story highlights

A North Carolina private school, Asheville Waldorf School, is experiencing the state’s most severe outbreak of chickenpox since the chickenpox vaccine became available in 1995. The school, which educates students from nursery school to sixth grade, had 36 cases as of November 16.

Only two other schools in North Carolina have higher rates of religious vaccination exemption than Asheville Waldorf. During the 2017–18 school year, 110 of the 152 students had not received the chickenpox vaccine, with 19 of the 28 kindergarteners being exempted from at least one state-mandated vaccine.

Before the chickenpox vaccine, the disease affected 90 percent of Americans. Since the vaccine became available, the prevalence of chickenpox has been greatly reduced, as the vaccine is about 90 percent effective. A study in the journal Pediatricsfound that the incidence rate has been 9 to 10 times lower since the vaccine became available.

The number of vaccine exemptions is growing. Since 2011, the percentage of children under 2 years old who fail to receive any vaccinations has quadrupled. Low vaccine rates are associated with outbreaks of preventable diseases, including the measles outbreak in California in 2015.

In a statement to Blue Ridge Public Radio, Asheville Waldorf School explained, “The school follows immunization requirements put in place by the state board of education, but also recognizes that a parent’s decision to immunize their children happens before they enter school.”

However, Jennifer Mullendore, the medical director of Buncombe County, North Carolina, was unambiguous in a news release: “We want to be clear: Vaccination is the best protection from chickenpox.”

North Carolina requires its students to obtain certain vaccinations, but allows for exemption based on medical advice or religious beliefs. Efforts to create more strict regulations have fallen through. In 2015, after protests, state legislators retracted a bill that would have ended religious vaccination exemption.

Forty-seven states allow religious vaccination exemption.

[Editor’s note: Learn more about the importance of immunizations and read about state school and childcare vaccination laws.]

National: Critics say new transplant rules will benefit big city medical centersexternal icon
The Washington Post   (12/05/2018)   Lenny Bernstein

Story highlights

The Organ Procurement and Transplantation Network (OPNT), the organization that manages liver distribution for transplants, has amended its allocation policy for the second time in a year.

The OPNT is moving toward a “sickest-first” model. The new guidelines remove geographic boundaries that allowed transplant centers to collect livers only from brain-dead donors in nearby hospitals. Under the new model, rather than livers within a geographic area going to individuals within that specific area, now OPNT will give top priority to the most critically ill individuals within a 500 nautical mile radius who are classified an emergency case. If no one meets that criterion, the new plan offers the liver to the next sickest patients within a 150, 250, and then 500 nautical mile radius.

Critics say the new policy will inevitability move livers from rural and low-income parts of the country to more metropolitan areas where populations and demand are larger. Raymond J. Lynch, a liver transplant surgeon and professor at Emory University School of Medicine in Atlanta, says, “This is a disaster. We should not kid ourselves. When you move a liver, you move a death.”

The United States struggles with a shortage of livers, lungs, hearts, kidneys and other organs for transplant. More than 13,500 people were on waiting lists for livers in 2017. Only 7,715 transplants were completed. Up to five people waiting for livers die daily.

In December 2017, the OPNT voted to move away from long-established boundaries and rules that specified where livers would be offered first. A group of patients who were dissatisfied with that vote filed a lawsuit in July 2018 arguing that they were on waiting lists for a longer period of time than others who were less ill in other regions. As a result, the transplant network reconsidered. The final vote was issued on December 3, 2018.

Motty Shulman, an attorney representing these patients, calls the 30-to-7 decision “a giant step” that would “benefit the over 13,000 individuals currently on the liver waitlist and thousands more in the years to come.”

[Editor’s note: Learn more about the Organ Procurement and Transplantation Networkexternal icon and the updated liver distribution systemexternal icon.]

Briefly Noted

Utah: Utah set to drop blood-alcohol limit to .05, strictest in countryexternal icon
NBC News   (12/16/2018)   Janelle Griffith
[Editor’s note: Read Utah’s House Bill 155, Driving Under the Influence and Public Safetyexternal icon, which will take effect December 30, 2018.]

Alaska: An earthquake created a highway hellscape in Alaska. Days later, the road reopened—good as newexternal icon
The Washington Post   (12/07/2018)   Amy B. Wang
[Editor’s note: Learn more about Alaska emergency managementexternal icon and emergency preparedness and recovery and transportationexternal icon.]

Hawaii: Man sues Hawaii, saying the false missile alert caused his heart attackexternal icon
CNN   (11/28/2018)   Doug Criss and Jeremy Grisham

Louisiana: This town is like thousands that are vulnerable to contaminated water, with no fix in sightexternal icon
CNN   (11/28/2018)   Sara Ganim

Louisiana: Louisiana is trying to keep medical marijuana medical. It’s harder than it soundsexternal icon
CNN   (11/27/2018)   Lydia DePillis
[Editor’s note: Read about state marijuana lawsexternal icon.]

Michigan: Federal ban on female genital mutilation ruled unconstitutional by judgeexternal icon
The New York Times   (11/21/2018)   Pam Belluck
[Editor’s note: Read the opinion in US v. Nagarwala, et al.pdf icon[PDF-217KB]external icon, US District Court Eastern District of Michigan, Southern Division, No. 17-CR-20274, filed 11/20/2018, Opinion by Judge Bernard A. Friedman.]

Ohio: This city’s overdose deaths have plunged. Can others learn from it?external icon
The New York Times   (11/25/2018)   Abby Goodnough

Wisconsin: Public Health launches violence prevention initiativeexternal icon
Wisconsin State Journal   (11/30/2018)   Dean Mosiman
[Editor’s note: Learn more about the Madison and Dane County, Wisconsin, initiative to reduce drug harm and violenceexternal icon.]

Wisconsin: An experiment requiring work for food stamps is a Trump administration modelexternal icon
The Washington Post   (11/29/2018)   Amy Goldstein

National: Babies of the opioid crisis seek their day in courtexternal icon
Politico   (11/29/2018)   Paul Demko

National: FDA approves ‘precision medicine’ drug for different cancers with same mutationexternal icon
The Washington Post   (11/26/2018)   Laurie McGinley

National: FDA say it’s OK to eat romaine lettuce again—just not from these California countiesexternal icon
USA Today   (12/14/2018)   Zlati Meyer
[Editor’s note: Read Statement from FDA Commissioner Scott Gottlieb, M.D. and FDA Deputy Commissioner Frank Yiannas on new findings and updated consumer recommendations related to the romaine lettuce E. coli O157:H7 outbreak investigationexternal icon, released 12/13/2018.]

National: U.S. climate report warns of damaged environment and shrinking economyexternal icon
Time   (11/23/2018)   Justin Worland
[Editor’s note: Learn more about the fourth national climate assessment.external icon]

Global Public Health Law

China: Claim of CRISPR’d baby girls stuns genome editing summitexternal icon
STAT News   (11/26/2018)   Sharon Begley

Democratic Republic of the Congo: Battle against Ebola in Congo pits medical hope against local chaosexternal icon
The New York Times   (11/27/2018)   Donald G. McNeil Jr.

France: France’s protesters are part of a global backlash against climate-change taxesexternal icon
The Washington Post   (12/04/2018)   Steven Mufson and James McAuley

Indonesia: Palm oil was supposed to help save the planet. Instead it unleashed a catastrophe.external icon
The New York Times   (11/20/2018)   Abrahm Lustgarten

Sri Lanka: Quiet casualty of Sri Lanka’s political crisis: a sugar taxexternal icon
The New York Times   (12/03/18)   Mike Ives

Global: As measles surges, ‘decades of progress’ are in jeopardyexternal icon
The New York Times   (11/29/2018)   Rich Gladstone

Profile in Public Health Law: Sheila Salvant Valentine, JD, MD

Legal and Policy Fellow, Division of HIV/AIDS Prevention, CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

JD, Georgia State University College of Law; MSHA, Georgia State University J. Mack Robinson College of Business; MJ, Widener University, Delaware Law School; MD, Universidad de Montemorelos, Montemorelos, Mexico

Public Health Law News (PHLN):Please describe your career path.

Salvant Valentine:While practicing medicine in a primary care setting, I realized that laws and policies can have a great impact on healthcare. I also realized that lawmakers, healthcare practitioners, and healthcare administrators did not see or approach healthcare issues the same way, although they all wanted the same outcome. For these reasons, I decided to pursue degrees in law and health administration to help bridge the communication gap between the key players in the healthcare system.

PHLN:What drew you into public health law?

Salvant Valentine:What I like about public health law is that I can use my different backgrounds in my everyday work.

PHLN:Please describe your role within CDC’s Division of HIV/AIDS Prevention (DHAP).

Salvant Valentine:As a legal and policy fellow, I lead the Legal Assessment Program within the policy team and also undertake other policy-related functions.

PHLN:What is the DHAP Legal Assessment Program?

Salvant Valentine: DHAP’s Legal Assessment Program implements public health law research methods to systematically collect and assess statutory and regulatory frameworks across a range of legal domains to help determine whether these legal frameworks act as barriers or facilitators to effective HIV prevention.

PHLN:How is law related to HIV/AIDS?

Salvant Valentine:Laws can have an impact on HIV prevention strategies. Some of these prevention strategies include diagnosing HIV through routine testing, linking people who test positive for HIV to care within 30 days of diagnosis, immediately treating people with HIV so they become virally suppressed, increasing the use of pre-exposure prophylaxis, and ensuring access to and use of condoms. Several states have laws that could impact HIV prevention strategies, such as HIV testing laws, laws on minors’ consent to HIV services, and laboratory reporting laws.

PHLN:What research projects have been added to the DHAP legal assessment program since you began working with the division?

Salvant Valentine:One research project is assessing the impact of scope of practice laws for nurse practitioners and physician assistants on prescribing pre-exposure prophylaxis. Another is evaluating the consistency of states’ perinatal HIV testing laws with CDC’s 2006 recommendations on HIV testing.

PHLN:What are HIV/AIDS criminalization laws, and how do they relate to public health?

Salvant Valentine:In 1990, the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act required every state to certify that its criminal laws were adequate to prosecute any HIV-infected individual who knowingly exposed another person to HIV. The majority of states have implemented HIV exposure laws criminalizing behaviors that could potentially expose another person to HIV.

Some of these state laws criminalize behavior that in actuality cannot transmit HIV, and the laws apply regardless of whether transmission occurred. For example, some states criminalize spitting, biting, and/or throwing body fluids by someone with HIV. (See editor’s note.) Science shows, however, that these behaviors have a negligible risk of transmitting HIV. Also, very few states include viral suppression as a defense, despite the fact that people with HIV who take HIV medicine (antiretroviral therapy) as prescribed and get and keep an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative sexual partners.

PHLN:How do HIV/AIDS criminalization laws vary between jurisdictions?

Salvant Valentine:Criminalization laws vary widely between jurisdictions. The type of criminalized behaviors (high-risk, low-risk, and negligible risk) varies between jurisdictions. The length of the sentence varies from a few years up to life in prison. Only a few states allow condom use and/or viral suppression as a defense. Also, some states use the disclosure of a person’s HIV status as an affirmative defense, while some states put the burden on the prosecution to show a lack of disclosure. In states with affirmative defense, charges against a person with HIV would be dropped if the defendant can show he or she disclosed the positive HIV status to the defendant’s partner.

PHLN:What, if any, impact do these criminal laws have on public health outcomes or the distribution of HIV/AIDS?

Salvant Valentine:The Legal Assessment Program published an ecologic analysis in 2017 that sought to assess whether there was any association between state criminal exposure laws and HIV and AIDS diagnosis rates in the United States. The results show that criminal exposure laws were not associated with HIV and AIDS diagnosis rates.

PHLN:How might law and policy be used to reduce new cases of HIV/AIDS and improve health?

Salvant Valentine:Laws and policies can directly impact HIV prevention efforts and help improve health outcomes. For example, states have enacted statutes and/or regulations that specifically require laboratory reporting of all levels of CD4 and viral load results. Viral load measurements indicate the number of copies of the HIV-1 virus that are in a milliliter of a person’s blood. CD4 results provide a measure of a person’s immune function and give information about a person’s white blood cells. Among people with HIV, CD4 results are often used to monitor disease progression, determine the stage of HIV infection, and make decisions about when particular treatments are appropriate. In addition, both viral load and CD4 data are used to assess whether patients are responding to treatment—when treatment is successful, CD4 counts rise and viral loads fall. Current HIV clinical management guidelines call for CD4 and viral load testing at the time of diagnosis and regularly thereafter. When all CD4 and viral load results are reported, public health agencies can better allocate resources for HIV prevention and care, monitor trends, address clusters, and ensure that people with HIV are in, and remain in, care.

PHLN: How can individuals learn more about HIV/AIDS and how to prevent it?

Salvant Valentine:A good place for people to learn more about HIV/AIDS and how to prevent it is the CDC HIV website.

PHLN:What other projects are you currently working on?

Salvant Valentine:I am currently working on a syringe services program case study and data privacy issues.

PHLN:Do you have any hobbies?

Salvant Valentine:I am trying to find time for hobbies. Currently, I am trying to get back to playing the piano.

[Editor’s note: Read more about HIV and STD criminal laws.]

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 January 2019 edition of the News.Email your entry to with “PHL Quiz” as the subject heading; entries without the heading will not be considered. Good luck!

Public Health Law NewsQuiz Question December 2018

Which state recently launched an initiative that treats incidents of violence as a public health issue?

Public Health Law NewsQuiz Question November 2018 Winner!
Photo: Michelle Leavy

Michelle Leavy

November Question:
Which country recently banned the sale of most firecrackers in an attempt to address heavy smog?

Winning Answer: India

Employment organization and job title:  OM1, Inc., Head of Healthcare Research & Policy

A brief explanation of your job: I design observational clinical research studies, such as patient registries, that use multiple data sources to answer questions about patient outcomes. I also work with a wide range of stakeholders to develop and share best practices in patient registry methodology. In particular, I am an editor of the Agency for Healthcare Research and Quality publication, Registries for Evaluating Patient Outcomes: A User’s Guide,which provides practical information on the design, conduct, analysis, and evaluation of patient registries.

Education: Columbia College (BA in comparative literature) and University of North Carolina Gillings School of Global Public Health (MPH)

Favorite section of the Public Health Law News:  Briefly Noted. It’s a great way to keep track of what is happening across the country.

Why are you interested in public health law? Public health law has a tremendous impact on so many levels, from the health of entire populations down to decisions in an individual’s daily life. I think it’s fascinating to see how states and countries take different legal approaches to similar issues and how public health law evolves in response to new technology. From a professional standpoint, my work involves observational data (collected through routine clinical care), and it is important to understand the implications of public health law for access to healthcare, patient privacy, and research ethics.

What is your favorite hobby? Hiking and snowshoeing in the Maine woods.

Quiz question honorable mention:Wilma Johnson submitted the first correct response for the November 2018 edition and was also the quiz winner in August 2018. Given how many responses we receive, we would like to give other quiz participants the opportunity to be featured. Therefore, this month we featured the participant who submitted the second correct response. Thank you, Ms. Johnson, for being a regular reader of Public Health Law News!”

Court Opinions

Minnesota: State has personal jurisdiction against Volkswagen in a state environmental protections claims, but the case is preempted by the federal Supremacy Clause and Clean Air Act.
State v. Volkswagen Aktiengesellschaftexternal icon
Court of Appeals of Minnesota
Case No. A18-0544
Filed 12/03/2018
Opinion by Judge Denise D. Reilly

Federal: Plaintiff, who is blind, alleged the city of Littleton, Colorado was negligent in maintaining a sidewalk from which she wandered into the street and was struck by a car. Court found the city was protected by sovereign immunity.
Lewis v. Powers external icon
United States District Court, D. Colorado
Case No. 1:15-CV-02692-MEH
Filed 11/30/2018
Opinion by Judge Michael E. Hegarty

Federal: Class certification granted for prisoners seeking better hepatitis C virus testing and treatment. Plaintiffs likely to succeed on merits of deliberate indifference claim.
Buffkin v. Hooksexternal icon
United States District Court, Middle District of North Carolina
Case No. 1:18CV502
Filed 11/30/2018
Opinion by Judge Joe L. Webster

Quote of the Month

“We have an affordable housing crisis that continues to ravage the city and we need to do better at getting housing for our most vulnerable families, the homeless and the very low income. The need to address the homelessness issue is so intense and dire that individuals are interrupting the mayor while he’s working out to ask him to do better.” Rafael Salamanca Jr., a councilman from the Bronx

[Editor’s note: This quote is from More housing for New York’s homeless? Council will weigh question mayor ignored at his gymexternal icon. The New York Times   (10/30/2018)   Jeffery C. Mays.]

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.


Subscribe to Public Health Law News or access past issues. To make comments or suggestions, send an email message to


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: December 20, 2018