Public Health Law News

February 2019


Policy Levers to Promote Access to and Utilization of Children’s Mental Health Services: A Systematic Review.external icon CDC has published an article on the evaluation of policy approaches to increase the use of children’s mental and behavioral health services. The evaluation found that services offered in schools and primary care facilities were used more by families and had a higher rate of satisfaction. Additionally, the evaluation examined policies related to insurance coverage for these services and found these services were becoming more affordable.

State Regulation of Community Paramedicine Programs: A National Analysis.pdf icon[PDF – 835KB] This month, CDC released a synopsis of “State Regulation of Community Paramedicine Programs: A National Analysis,” published in Prehospital Emergency Carein 2018. Community paramedicine provides medical services outside of emergency response to individuals who do not have insurance or transportation. The article details current state laws and regulations on state emergency medical services.

American Bar Association (ABA) Webinar—Getting to Know Government Attorneys: A look at CDC and CMS.external icon Register now for this webinar to hear insight and expertise from attorneys who work for CDC and the Centers for Medicare and Medicaid Services. The webinar is hosted by ABA’s Health Law Section Government Attorneys Task Force, Public Health and Policy Interest Group, and Young Lawyers Division. The webinar will be February 27, 2019, from 2:00 to 3:00 pm (EST), and will have a live question and answer segment.

Job Openings: Law and Policy Analyst Positions.external icon The Policy Surveillance Program at Temple University is seeking lawyers and law school graduates for several full-time positions. The positions are centered on public health law research and quantitative legal datasets. Applicants must have a JD and one year of related work or research experience. The application period will remain open until the positions are filled.

Exploring Policy Surveillance: Five-Part Webinar Series.external icon The Center for Public Health Law Research is hosting 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 next webinar in the series will take place March 12, 2019, from 1:00 pm to 2:30 pm (EDT), and will explore the challenges and opportunities in local policy surveillance. It will also share use cases, such as, and will identify and examine the practical and methodological barriers facing local practitioners using policy surveillance.

Law Enforcement and Public Health: Recognition and Enhancement of Joined-Up Solutions.external icon The Lancethas published an article on the relationship between security and public health. The article says law enforcement is an effective way to promote public health, but more attention needs to be paid to this relationship to improve policing. The paper is part of a series emphasizing the importance of how security and public health work together.

Legal Tools

Tackling the Opioid Crisis: What State Strategies Are Working?external icon This report identifies a few key strategies that are being used to address opioid abuse. The report was created by the National Academy for State Health Policy (NASHP) under a National Organizations of State and Local Officials cooperative agreement with the Health Resources and Services Administration.

Additionally, NASHP’s Center for State Prescription Drug Pricingexternal icon creates drug importation model legislation and toolkits based on existing legislation from Vermont. The program helps states that want to purchase lower-cost drugs from Canada, but it can be used as a tool to survey legislation related to prescription drugs and the transparency of cost to the public.

Comparative Analysis on Hurricane Relief in Three US Jurisdictions.external icon BMJ Global Healthhas published “Quantifying Inequities in US Federal Response to Hurricane Disaster in Texas and Florida Compared with Puerto Rico.” The article details the effectiveness of federal disaster relief and how health equity is affected.

Maternal and Child Health Database.external icon This database from the National Conference of State Legislatures gathers and categorizes all recent laws on maternal and child health. The laws, organized into fourteen topics within this database, include child nutrition, infant mortality, breastfeeding, and maternal and child mental health.

Top Stories

Washington: Measles patients are mostly children. Here’s whyexternal icon
PBS NewsHour   (01/29/2019)   Jamie Leventhal

Story highlights

In 2000, the Centers for Disease Control and Prevention declared measles eradicated from the United States. When measles enters the nation from other countries, however, it can rapidly affect unvaccinated populations, as was the case in Washington State. On January 25, Governor Jay Inslee declared a public health state of emergency after more than two dozen cases of measles were confirmed. A majority of cases involved children.

Of the 37 total cases, 36 were located in Clark County, Washington, on the border of Portland, Oregon. Thirty-five patients were under the age of 18 and 32 of them had not received the measles, mumps, and rubella (MMR) vaccine. Oregon faces a large threat from the outbreak because of the high vaccination exemption rates among the state’s schoolchildren, which has grown from a rate of 1 percent in 2000 to 7.5 percent in 2016, the highest exemption rate in the country.

Children are especially at risk of contracting measles. This is because adults are more likely to have had the vaccine or to have contracted measles if born before vaccination started. Children also interact in closer quarters with each other, allowing a highly infectious disease like measles to spread quickly.

CDC reports that the number of unvaccinated individuals has grown, and in one school district in Clark County, Washington, less than 44% of kindergarteners have received all immunizations required to enter school.

“All you have to do is bring measles into a community where you have a large unvaccinated population, and it can spread like wildfire,” says Alan Melnick, Clark County’s public health director.

Washington and Oregon public health officials are working to identify new cases and control the outbreak, which takes a toll on government resources. Lawmakers in Washington have proposed a bill to ban philosophical and personal exemptions specifically for the MMR vaccine for children in both public and private schools and daycare.

[Editor’s note: Learn more about the proclamation by the governorpdf icon[PDF -51KB]external icon, the billexternal icon, state school and childcare vaccination laws across the United States, and measles.]

Massachusetts: Lawsuit details how the Sackler family allegedly built an OxyContin fortuneexternal icon
NPR   Christine Willmsen and Martha Bebinger   (02/01/2019)

Story highlights

The owners of Purdue Pharma, the company that produces OxyContin, are the subject of a lawsuit filed by the Massachusetts attorney general. The lawsuit alleges members of the Sackler family were paid more than $4 billion dollars from 2008 to 2016 by Purdue Pharma to drastically increase sales of the opioid OxyContin while knowing it to be highly addictive. Additionally, the family is accused of using the profits to pay themselves hundreds of millions of dollars. The Sacklers served as executives and on the board for Purdue Pharma during that time.

Purdue Pharma has faced numerous lawsuits in the past decade, including suits by family members of people who were harmed by or died from OxyContin. In 2009, the company paid $2.7 million to settle such lawsuits, while allocating an additional $121.6 million to marketing the drug and $335 million to Sackler salaries that same year.

Despite the evidence of OxyContin’s addictiveness, Purdue Pharma and the Sacklers dramatically increased the sale of the drug with the help of a consulting firm, according to the Massachusetts lawsuit. The complaint says they labeled addicted individuals as “junkies” and “criminals” in public ad campaigns and repeatedly made aggressive marketing decisions, acknowledging the drug’s danger in private but denying the addictiveness of opioids in public.

Purdue says the suit is “part of a continuing effort to single out Purdue, blame it for the entire opioid crisis, and try the case in the court of public opinion rather than the justice system.” The company has attempted to keep salary numbers private and many pages of the lawsuit redacted. The entire lawsuit was recently made public through a court order.

[Editor’s note: Learn more about prescription opioids and the lawsuitpdf icon[PDF – 478MB]external icon.]

Briefly Noted

California: San Francisco’s warning labels on sugary drinks blocked by courtexternal icon
Governing    (02/02/2019)   Tribune News Service
[Editor’s note: Read the opinionpdf icon[PDF – 197KB]external icon and learn more about the effect of sugary drink warning labelsexternal icon.]

Maryland: Maryland judge dismisses lawsuit seeking to protect Affordable Care Actexternal icon
The Washington Post   (02/01/2019)   Amy Goldstein
[Editor’s note: Learn more about the casepdf icon[PDF – 308KB]external icon.]

Massachusetts: Federal judge: state fails to provide prompt mental health care to poor childrenexternal icon
The Boston Globe   (02/11/2019)    Liz Kowalczyk

Michigan: Governor Whitmer signs executive order announcing Dept. of Environment, Great Lakes, and Energyexternal icon
The Office of Governor Gretchen Whitmer   (02/04/2019)

New Jersey: NJ to allow cannabis for rising opioid abuseexternal icon
The Two River Times   (01/23/2019)   Chris Rotolo
[Editor’s note: Read about New Jersey’s new initiatives to combat the opioid epidemicexternal icon and learn more about current measures on opioid abuse preventionpdf icon[PDF – 286KB]external icon.]

North Carolina: North Carolina receives $4.5 million early childhood grant, Governor Cooper announcesexternal icon
North Carolina Department of Health and Human Services  (01/15/2019)

National: Black southerners are bearing the brunt of America’s eviction epidemicexternal icon
Pew   (01/18/2019)   Max Blau
[Editor’s note: Learn more about the association between health and housingexternal icon and gentrification.]

National: Giving medicine to young children? Getting the dose right is trickyexternal icon
NPR   (02/11/2019)   Patti Neighmond
[Editor’s note: Read FDA’s guidance, Reducing Fever in Children: Safe Use of Acetaminophenexternal icon.]

National: The vape company Juul said it doesn’t target teens. Its early ads tell a different story.external icon
Vox   (01/25/2019)   Julia Belluz
[Editor’s note: Learn more about advertising e-cigarettes to youth.]

Profile in Public Health Law: Julie Ralston Aoki
Photo: Julie Ralston Aioki

Title: Director of Healthy Eating and Active Living Programs, Public Health Law Center, Mitchell Hamline School of Law

Education: BA, East Asian Studies, Yale College; JD, The University Iowa College of Law

Public Health Law News (PHLN):How did you become interested in law?

Ralston Aoki:I believe that it’s my duty as a human being to do something to help correct and challenge inequity and injustice, every single day. And I thought that being a lawyer would give me tools to do that. After I graduated from college, I had a job working with low-income women, then I got a one-year fellowship to research the lives of modern Japanese women, and then I worked for the University of Indiana’s Affirmative Action Office. These experiences, on top of my own life experiences as a biracial, Asian American woman with an immigrant parent, and hearing my parents’ stories about growing up in poverty, helped me to realize that I wanted to work on behalf of socially disadvantaged and marginalized people. I also realized I needed some concrete tools and skills training to be useful. So I decided to become a lawyer.

PHLN:Please describe your career path.

Ralston Aoki:As a law student, I planned to be a legal aid attorney, and I clerked for the Legal Aid Foundation in Chicago during my first summer in law school. But I was hearing about hiring freezes and how the budgets for legal aid organizations were being cut, so I was worried about my prospects. For my second summer, I clerked for the Minnesota Attorney General’s Office as part of its summer law clerk program and subsequently was offered a job as an assistant attorney general. I was thrilled to take it—the office was taking Big Tobacco to court at the time and was nationally respected as a consumer protection leader. I felt lucky to be placed in the Antitrust Division, which was the sister division to Consumer Protection. A few years later, the two divisions merged, so I mostly did consumer protection work. After about ten years there, I was ready for a change and took an opportunity to join the staff here at the Public Health Law Center.

PHLN:Working in the consumer protection division of the Minnesota Attorney General’s Office doesn’t seem like an obvious start to a career in public health law. How is consumer protection related to public health?

Ralston Aoki:It was a natural fit—as I mentioned before, when I joined the Minnesota Attorney General’s Office, the Consumer Protection Division was immersed in one of the most important public health cases of our age, the case against Big Tobacco, which sought to hold the major cigarette makers accountable for decades of lies to the public about the health hazards of smoking. I think both consumer protection and public health law are grounded in ideas of social justice and the idea that it is the job of government to look out for its people, particularly for people who are vulnerable, or socially disadvantaged or marginalized.

PHLN:What is the Public Health Law Center?

Ralston Aoki:At the Public Health Law Center, we believe that everyone deserves to be healthy. We are a nonprofit legal technical assistance center that collaborates with others to reduce and eliminate commercial tobacco, promote healthy food, support physical activity, and address other causes of chronic disease. Our goal is to help our partners develop public health laws and policies that are grounded in good science as well as good law and that are responsive to the needs and priorities of community members, particularly those who are most negatively impacted by health disparities. Our belief in health and equity for all people is at the core of our work

PHLN:Please describe your current position.

Ralston Aoki:I am the director of our HEAL team. I manage a team of nine public health law and policy experts, including attorneys, a behavioral scientist, and a community planner. We just added the planner to our team and are very excited about growing our work related to public health policy and planning. I also lead our work with Tribal communities and organizations on Tribal public health work.

PHLN:How is law related to healthy eating and active living?

Ralston Aoki:The law relates to this in so many ways, both good and bad. The law shapes where we live, how our communities are designed, what kinds of food we have access to, our transportation systems, our workplaces, and so on. It drives our choices and opportunities in a myriad of ways. An important example is segregation laws and policies, which shaped where African American people and other people of color could live, the quality of housing available to us, and what public facilities we could access (e.g., swimming pools). The effects of these laws continue today.

Law also directly influences our food system and access to healthy food—from federal laws such as the Farm Bill; the Healthy, Hunger-Free Kids Act; and federal food safety laws to state or local consumer protection laws that require menu labeling or sodium warnings. Sugary drink taxes raise money for healthy eating, active living, and equity initiatives while making sugary drink purchases less convenient. The same applies for active living—zoning and licensing laws dictate where parks are located and the availability of sidewalks and bike paths. Planning policies can encourage or discourage active transportation options and the availability of green spaces and clean water.

PHLN:What kind of services and resources does the Public Health Law Center’s healthy eating and active living team provide and to whom?

Ralston Aoki:We do a lot of work in the Midwest, but we also work with national groups, such as the American Heart Association, and with state and local public health staff and advocates all over the United States and Indian Country. We also work with researchers, community leaders, government attorneys, and other officials at all levels of government. We work through contracts and grants, so where and with whom we work is often driven by that. We collect and translate legal research to help people understand the policy landscape they are working in—in other words, how other laws (Tribal, federal, state, local) might impact their goals or policy ideas. We help by identifying possible policy opportunities and providing examples or ideas from other jurisdictions or communities. We work with community planners and public health groups to incorporate HEAL and equity principles into planning policies. And we try to help make sure that policy work is inclusive and grounded in community realities.

We don’t lobby, but we can work with advocates to understand legislative and other policy language and possible intended and unintended consequences, and we can educate policymakers and others about legal questions that impact healthy eating, active living, and health equity policy development. We prefer to tailor our work to the specific community we are working with to make sure what we are doing is as relevant as possible, but we also provide more general publications, webinars, and web-based tools.

PHLN:What kind of legal interventions are you asked about most often?

Ralston Aoki:It really depends—HEAL work covers so many different areas, and questions can be based on what’s in the public consciousness.  For example, we’ve become known for expertise on the policies that impact child care settingsexternal icon, so we often get questions relating to child care and other early care and education settings.  We also get a lot of questions relating to how to embed healthy eating, active living, and equity concerns into community planningpdf icon[PDF – 5.5MB]external icon.  There is a lot of interest in policy tools to address sugary drink consumptionexternal icon, such as sugary drink taxes.

Finally, we also get questions about what to do when law gets in the way—for example, how to deal with food safetyexternal icon concerns in ways that don’t create barriers for healthy food access at places like food shelves and farmers’ markets. Another good example of this is preemptionexternal icon—which is where the federal or state government takes away or limits local authority to regulate a certain area.  Preemption is a legal intervention most commonly used by opponents of public health measures to block policy development.  Industry groups are using it to thwart progress on a wide variety of public health fronts, and healthy eating measures are often targeted—including sugary drink taxes, menu labeling, and laws that address food-based health disparities—as well as living wage laws, paid leave laws, affordable housing laws, and other laws that really impact the social determinants of health. Preemption comes up a lot in our work.

PHLN:How is the Public Health Law Center supporting innovative programs aimed at improving access to healthy food?

Ralston Aoki:One thing we’re doing is encouraging people to think about equity and inclusion in the policy-making process from the get-go and throughout. Walking on this path takes us upstream to how the social determinants of health impact access to healthy food—it requires us to consider how communities prioritize healthy food access in connection with clean water access or safe, affordable housing, etc. How we approach this is context-specific—so much depends on the group, where they are at in their own understanding of equity principles, and what they are striving to accomplish. We try to ask thought-provoking questions, identify gaps in perspectives, and provide trainings to help frame policy work with an equity lens. We also developed a resourcepdf icon[PDF – 183KB]external icon to help people think about how they could “bake” equity and inclusion into their policy process.

Another project that we are really proud of is the Healthy Food Policy Projectexternal icon (HFPP), which is a collaborative project with the Rudd Center on Food Policy and Obesity at the University of Connecticut and the Vermont Law School’s Center for Agriculture and Food Systems. Through the HFPP, we’ve created a unique set of online tools to help food policy councils, local community leaders, food security advocates, and others get ideas for how to use local government power to improve access to healthy food in ways that apply a more holistic approach to health. The HFPP includes a database of local laws that we have analyzed and categorized based on geography, stages of the food system, and type of legal strategy.

PHLN:What kind of policies is the Healthy Food Policy Project tracking?

Ralston Aoki:HFPP identifies and elevates municipal laws that seek to promote access to healthy food and contribute to strong local economies, an improved environment, and health equity, with a focus on socially disadvantaged and marginalized groups. While the HFPP also includes information about land use planning and administrative policies, the focus is on codified laws that promote access to healthy food in some way across the stages of the food system, from growing or raising food to distribution to dealing with unused or wasted food. So it’s a big range—from zoning laws that regulate community gardens, to menu labeling laws, to tax incentives for new grocery stores, to laws that protect breastfeeding in the workplace, to laws for curbside composting of food scraps.

PHLN:How can individuals and community leaders learn more about healthy food policy and its implementation?

Ralston Aoki:First, do a little research about the efforts that may already be underway in the community or region—many communities have food policy councils or similar groups, whether established by a government agency or by community groups. If this kind of group doesn’t exist in your area, other groups may be doing (or interested in doing) food systems work that relates to healthy food policy, such as a local health department, local healthcare systems, hunger relief organizations, community garden groups, farmers’ market organizations, faith-based organizations, public health advocacy groups (such as local or regional American Heart Association affiliates) and other community groups. If an extension office or Tribal college or university is in your area, their staff may also be a resource or be engaged in healthy food systems work that you could tap into.

The Public Health Law Center also has several new resources to help communities understand and use land use planningexternal icon to pursue healthy eating, active living, and health equity policy goals. For example, we have a resource on Hunger Relief in Local Planningpdf icon[PDF – 5.5MB]external icon, and a new Local Plan Implementation Toolkitexternal icon designed to help communities think about how to operationalize public health policies that are within their comprehensive plans and other types of plans. The Public Health Law Center websiteexternal icon, of course, also has many other resources.

PHLN:What advice would you give communities struggling with improving their food policies?

Ralston Aoki:Take it step by step. Be open minded—it takes flexibility, compromise, and patience. Start with connecting to or building a strong coalition or network that has a core membership built around community members who are the intended beneficiaries of the policy work. Come with ideas but be open to hearing different perspectives and learn to see challenges from multiple viewpoints. This also means being willing to adapt or even discard your ideas for new ones as the work evolves. Don’t sacrifice the good for the perfect. Collect information—data is very useful and powerful for helping people to understand the issues, applying for grants, and figuring out what you need from a policy. Also, you may find that you are starting from a stronger place than you realize.

PHLN:What other projects are you working on currently?

Ralston Aoki:We also provide legal technical assistance to Tribal public health departments and advocates to support healthy Tribal food systems work, and we are working with public health researchers at the University of Minnesota on a project to examine municipal alcohol control policies.

PHLN:Do you have any hobbies?

Ralston Aoki:I have three kids in school so that doesn’t leave much spare time, but I like to read science fiction and watch superhero shows, and I’m learning to play the ukulele.

PHLN:Do you have anything you’d like to add?

Ralston Aoki:Thank you for the opportunity to do this!

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 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 February 2019

The February 2019 edition of the news includes a story about HIV patients’ records being exposed in which country?

January 2019 Quiz Winner
Photo: Pat Kreitler, MN, BSN, RN

Pat Kreitler, MN, BSN, RN

January Question: Which state now requires changing stations in men’s public restrooms?

Winning Answer: New York

Employment organization and job title: Arizona Care Hospice, Inc., Regional Director of Compliance and Education

A brief explanation of your job: I oversee and teach at all of our hospice sites, and I maintain our accreditation for compliance with Medicare and all regulatory agencies, such as the state of Arizona and CHAP (Community Health Accreditation Partner). I oversee our internship program for student nurses and social workers. I teach clinical care (patient care) and management to hospice staff, and I am a hospice consultant nationally.

Favorite section of the Public Health Law News:My favorite sections of the Public Health Law Newsare the court opinions and top stories.

What are your favorite hobbies? Cooking and reading.

Court Opinions

Delaware: The state sued opioid manufacturers, drug distributers, and pharmacies for damages, restitution, disgorgement, and civil penalties because the defendants allegedly violated their duty to disclose the risks associated with opioid medication. The state argued that the manufacturer defendants misrepresented the risks of opioids to certain audiences and knew or should have known that their statements were false and misleading. The state argued that the distributer defendants failed to uphold their duty to actively prevent opioid diversion, and that the pharmacy defendants did not uphold their duty to prevent opioid diversion and report any suspicious orders. The counts were consumer fraud, nuisance, negligence, unjust enrichment, and civil conspiracy. The court held that the state established a prima facie case for negligence and consumer fraud against the manufacturer and distributor defendants, but not against the pharmacy defendants.

State of Delaware v. Purdue Pharma, L.P.external icon
Superior Court of the State of Delaware
Civil Action No. N18C-01-223 MMJ CCLD
Decided 02/04/2019
Opinion by Judge Mary Miller Johnston

New York: The New York City Housing Authority (NYCHA) was not entitled to summary judgment in a negligence action brought on behalf of a child diagnosed with lead poisoning because 1) the plaintiff raised an issue of fact for trial and 2) the NYCHA did not demonstrate that no hazardous condition existed in the apartment as a matter of law. The court held that the findings from the authenticated business reports were insufficient to establish the NYCHA’s prima facie entitlement to summary judgment as a matter of law. Further, the local lead paint law establishing the presumption of no actionable level of lead paint does not apply to an apartment building where a child diagnosed with lead poisoning lives, despite evidence that some portions of the building were erected before the trigger date that would otherwise create the presumption.

A.L. v. New York City Housing Authorityexternal icon
Appellate Division of the Supreme Court of the State of New York
Case No. 305654/11 7399
Filed 01/31/2019
Opinion by Justice Peter H. Moulton

Federal: A Navy Vietnam veteran appealed a decision by the Court of Appeals for Veterans Claims, which denied his claim for compensation for chronic diseases from Agent Orange exposure. Pursuant to 38 U.S.C. § 1116, illnesses of US veterans who served in the Republic of Vietnam are presumed to be connected to service during exposure to herbicides such as Agent Orange. Historically, this presumption has been extended only to veterans who served within the landmass or inland waterways of the Republic of Vietnam. The immediate case extends this presumption to veterans who served in waters offshore from the Republic of Vietnam.

Procopio v. Wilkieexternal icon

United States Court of Appeals, Federal Circuit
Case No. 2017-1821
Decided 01/29/2019
Opinion by Circuit District Judge Kimberly A. Moore

Quote of the Month

“Evictions are both a consequence of cumulative forces of poverty—and black poverty—and a cause of it. Evictions hurt folks in all kinds of ways. Because evictions are concentrated in black neighborhoods, it impacts whole communities.” Dan Immergluck, an urban studies professor at Georgia State University

[Editor’s note: This quote is from Black southerners are bearing the brunt of America’s eviction epidemic.external icon Pew   (01/18/2019)   Max Blau

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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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: February 21, 2019