Public Health Law News

May 2019

Letter from the Editor

The Public Health Law Program (PHLP) thanks Kathryn Ayres for her assistance in writing the January–June 2019 editions of Public Health Law News.Ms. Ayres interned with PHLP while pursuing bachelor of arts degrees in Arabic and international affairs from the University of Georgia and graduated with both degrees in May 2019.

PHLP also thanks Julia M. Shelburne for her help researching and briefing the cases for the January–May 2019 editions of the News.Ms. Shelburne will graduate with her juris doctor from the University of Georgia in May 2019.

PHLP also thanks Matthew Ishihara for his assistance with cases for the January 2019 edition of Public Health Law News.Mr. Ishihara is expected to graduate with his master of public administration and juris doctor from the University of Georgia in May 2020.

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

Announcements

An Assessment of State Laws Providing Gubernatorial Authority to Remove Legal Barriers to Emergency Responseexternal icon. A recent publication in Health Securityexamines 50 state laws to determine the legal power that governors have to modify or create laws to facilitate a quicker emergency response. This article outlines the findings of the 50-state assessment and gives examples of how governors have used this legal authority during emergencies.


2019 Public Health Law Summit: Data Sharing to Improve Community Healthexternal icon. The Network for Public Health Law is hosting a summit October 3–4, 2019 in Plymouth, Michigan. It will focus on current data-sharing strategies in a multisector approach to improving community health. The sessions will emphasize the need to comply with law and maintain community trust when sharing data.


School Discipline Policies, 2008-2018external icon. School discipline laws regulate the use of exclusionary discipline for students, such as expulsion and suspension from school. There has been a recent trend in the United States toward reevaluating expulsion and suspension policies. A number of states have revised their laws since 2008 to reduce expulsions and suspensions, and 13 states have banned the use of exclusionary discipline for certain ages or grade levels. New legal data published in LawAtlas.org, in partnership with CDC’s National Center for Injury Prevention and Control, traces nearly 11 years of state “zero tolerance” school discipline policies. This publication was supported by Cooperative Agreement Number NU38OT000141 awarded to ChangeLab Solutions and funded by CDC.


Supplemental Security Income Laws, 1996–2018. The federal Supplemental Security Income (SSI) program assists low-income individuals who are living with a disability or who are 65 years old or older. LawAtlas, in partnership with CDC’s Division of Human Development and Disability, has released two maps about supplemental income laws for children with disabilities. These publications were supported by Cooperative Agreement Number NU38OT000141 awarded to ChangeLab Solutions and funded by CDC.


Pay to Play? State Laws Related to High School Sports Participation Feesexternal icon. A new article in the Journal of Public Health Management and Practiceanalyzes the laws and regulations on sports participation fees and the impact of these laws. Pay-to-play fees are created when school sports programs can no longer be supported by a school’s budget.


Status of Protections in the U.S. for Victims of Domestic Violence in Same-Sex Relationshipspdf icon[PDF – 1.20MB]external icon. The Network for Public Health Law has published an issue brief on how unmarried same-sex couples are protected under domestic violence laws. When the landmark Obergefellcase in 2015 allowed same-sex couples to marry, same-sex couples also became protected under the law in domestic violence cases. However, the laws are questionable as to whether unmarried couples have equitable protections under domestic violence laws.


Webinar: Advancing the Community Health Worker Workforce through Law and Policyexternal icon. Community health workers (CHWs) are key members of healthcare teams and the public health workforce. With their close understanding of the communities they serve, CHWs are uniquely suited to help address root causes of poor health. As the CHW workforce grows, continuously evolving state laws and policies have the potential to improve public understanding of the CHW role and facilitate sustainable financing for CHWs. This free webinar will take place June 30, 2019, from 1:00 to 2:30 pm (EDT). It is hosted by the Network for Public Health Law in partnership with CDC’s Applied Research and Evaluation Branch in the Division of Heart Disease and Stroke.

Legal Tools

Racial and Ethnic Disparities in Adult Obesity in the United States: CDC’s Tracking to Inform State and Local Action. CDC tracks data on the burden of obesity and related disparities among ethnic and racial groups to demonstrate where state and local action needs to be a priority. This article reports that adult obesity continues to rise, especially among minorities and people who had obesity as children.


Concerns About Opioid Use in Medicare Part D in the Appalachian Regionexternal icon. The US Department of Health and Human Services has published a study examining opioid-related overdose deaths in five states in the Appalachian region, using Medicare Part D records received in 2017. These states had very high opioid prescribing rates and death rates. The study concludes that it’s possible opioids in the Appalachian region are being unnecessarily prescribed and then diverted for resale or recreational purposes.


The Legal Determinants of Health: Harnessing the Power of Law for Global Health and Sustainable Developmentpdf icon[PDF – 1MB]external icon. The Lancet-O’Neill Institute Commission on Global Health has published a report about how law is used as a tool to advance global health. The report details seven recommendations to implement evidence-based policy initiatives to mitigate modern health risks.


The Impact of Chronic Underfunding of America’s Public Health System: Trends, Risks, and Recommendations, 2019external icon. This annual report from Trust for America’s Health details local, state, and federal public health funding and recommendations for investment and policy initiatives.


Visualizing Data About the Healthy Schools Policy Landscapeexternal icon. Child Trends has published a comprehensive policy analysis of laws related to the Whole School, Whole Community, Whole Child framework in all 50 states and the District of Columbia. The report addresses 195 topic areas within the 10 domains of the framework. An interactive visualization is published with the report to show each state’s approach.


PUP in Smoke: Why Youth Tobacco Possession and Use Penalties Are Ineffective and Inequitableexternal icon. This ChangeLab Solutions report examines whether laws that prohibit youth possession, use, and purchase of tobacco products (PUP laws) improve health. The report concludes that these laws are often ineffective and inequitably enforced and that Big Tobacco is not held accountable for youth tobacco addiction.

Top Stories

National: County jails struggle with a new role as America’s prime centers for opioid detoxexternal icon
NPR   (04/24/2019)   Eric Westervelt

Story Highlights

America’s county jails are inadvertently becoming opioid treatment centers. County jails may be their area’s largest drug treatment centers, with jails adding medication-assisted treatment (MAT) to safely help inmates who are detoxing from opioids and to keep them clean. Concerns about the efficacy and costs of these programs have risen.

“It was never traditionally the function of jail to be a treatment provider, nor to be the primary provider of detoxification in the country—but that is what they have become,” says Andrew Klein, the senior criminal justice research scientist with Advocates for Human Potential, a company that advises on substance abuse treatment programs in jails.

County jails have started these programs because of the number of inmates who are addicted to opioids. According to the National Sheriffs’ Association, at least half to two-thirds of the nation’s jail population has a drug problem.

Peter Koutoujian, the sheriff of Middlesex County, Massachusetts, says, “We have to physically, medically detox about 40% of our population as they come in off the street, and probably 80 to 90% of our population inside has some type of drug or alcohol dependence.”

Due to demand for MAT in jails, the National Sheriffs’ Association has issued a best practices guide to jail-based medication-assisted treatment. Although sheriffs say treatment should be available in the community, incarceration presents an opportunity to intervene in the crisis.

Many jails face obstacles to this form of treatment: inmates may not be in jail long enough to receive effective treatment, some jails lack the resources to obtain or be certified to carry methadone (a drug commonly used for MAT), and rural areas may not have a doctor who is certified to administer these treatments. To break down obstacles, the National Sheriffs’ Association is trying to get medical waivers from federal partners to expand telemedicine and mobile anti-opioid addiction units. In addition, the Massachusetts legislature has approved a pilot program in seven counties for evidence-based opioid treatment in jails.

[Editor’s note: Learn more about Massachusetts’s initiativeexternal icon, MATexternal icon, and best practices for jailspdf icon[PDF – 1.2MB]external icon.]


National: In Washington, Juul vows to curb youth vaping. Its lobbying in states run to counter that pledge.external icon
The New York Times   (04/28/2019)   Sheila Kaplan

Story Highlights

The e-cigarette manufacturer Juul has pledged to lawmakers in Washington that it is committed to keep teenage vaping down. Across the country, however, Juul lobbyists are fighting calls to ban the flavored e-cigarette pods that attract teenagers. With 80 lobbyists in 50 states, Juul is advocating for legislation that would prevent local governments from adopting vaping restrictions. This is in sharp contrast to the company’s support for bills raising the legal age for buying tobacco to 21 (Tobacco 21 legislation).

“Juul is attempting to rehabilitate its public image by posing as a public health advocate while working behind the scenes to weaken or defeat tobacco control proposals and prevent communities from even considering policies to curb tobacco use,” says Nancy Brown, chief executive of the American Heart Association.

Juul has created an action plan that includes deleting its social media accounts, discontinuing many of its flavored vape pods, and tightening age restrictions on its website. The company denies it is marketing to teenagers but is facing regulatory threats from the Trump administration.

The company says its lobbyists are advocating for Tobacco 21 legislation, but many public health experts say these measures contain “poison pills.” The lobbyists are working to advance Tobacco 21 legislation that will prevent further regulations on tobacco products. Their advocacy is sometimes public, causing public health experts to not support Tobacco 21 legislation that is supported by Juul; at others times, the lobbyists’ work is not so visible. In South Carolina, Juul did not take a public position on a proposal to pre-empt local governments from banning e-cigarettes or otherwise regulating tobacco products. However, in a hearing, one of Juul’s lobbyists testified in favor of the plan. Some of these pre-emption measures have come from model legislation written by the Vapor Technology Association or from Altria, maker of Marlboro cigarettes.

[Editor’s note: Learn more about teens and vapingexternal icon and ads that target youth.]


National: Top executives of Insys, an opioid company, are found guilty of racketeeringexternal icon
The New York Times   (05/02/2019)   Gabrielle Emanuel and Katie Thomas

Story Highlights

Top executives of Insys Therapeutics have been found guilty of racketeering tied to the opioid epidemic. The company is accused of conspiring to increase sales by bribing doctors to prescribe the fentanyl-based painkiller Subsys. The executives were also accused of deceiving insurers about patients’ need for the drug.

The verdict is the latest development in efforts to hold accountable companies accused of contributing to the opioid epidemic. Last month, Rochester Drug Cooperative became the first pharmaceutical distributer to be charged by federal authorities. That company and its executives are accused of shipping tens of millions of oxycodone pills and fentanyl products to illegal distributors. Additionally, Massachusetts and New York are in the midst of lawsuits against Purdue Pharma and its owners, members of the Sackler family. And West Virginia settled with McKesson Corporation, which was accused of distributing 100 million doses of opioids to the state’s residents over six years.

“Just as we would street-level drug dealers, we will hold pharmaceutical executives responsible for fueling the opioid epidemic by recklessly and illegally distributing the drugs, especially while conspiring to commit racketeering along the way,” says US attorney, Andrew E. Lelling.

Insys’s marketing plan to increase sales of its drug was laid out over the ten-week trial. Prosecutors said the company paid doctors for fake education talks and to write prescriptions for more patients than the drug was approved for. Insys was accused of misinforming insurance companies to get them to cover the high cost of the drug. Former Insys sales representatives testified that their bonuses were tied to the dosages of Subsys prescribed by the doctors they recruited. The drug costs more at higher doses. Subsys is 100 times more potent than morphine, and more than 200,000 people have overdosed over the last two decades.

Briefly Noted

Arizona: Dueling bills in Arizona legislature target vaping, tobaccoexternal icon
AP   (04/29/2019)   Bob Christie
[Editor’s note: Read Arizona’s SB1147external icon and HB 2357external icon.]


California: Overlooked mental health “catastrophe”: vanishing board-and-care-homes leave residents with few
optionsexternal icon

CALmatters   (04/15/2019)  Jocelyn Wiener
[Editor’s note: Learn more about the importance of safe housingexternal icon for mental illness supportexternal icon.]


Vermont: Vermont bill requires testing for PFAS in drinking waterexternal icon
AP   (04/29/2019)   Lisa Rathke
[Editor’s note: Read the billpdf icon[PDF – 676KB]external icon.]


National: U.S. environment agency says glyphosate weed killer is not a carcinogenexternal icon
Reuters   (04/30/2019)   Tom Polansek
[Editor’s note: Read the EPA statementexternal icon.]


National: FDA approves first generic naloxone nasal spray to treat opioid overdoseexternal icon
U.S. Food & Drug Administration   (04/19/2019)
[Editor’s note: Learn more about naloxoneexternal icon.]


National: Number of measles cases in the U.S. reach 704, the highest point this centuryexternal icon
USA Today   (04/29/2019)   Ken Alltucker
[Editor’s note: Read more about measles and vaccination laws.]

Global Public Health Law

China: China fines a hospital for administering potentially fake vaccinesexternal icon
Bloomberg   (04/29/2019)


Germany: Germany considers fining parents over $2,700 if they don’t vaccinate childrenexternal icon
The Hill   (05/05/2019)   Emily Birnbaum


Mozambique: Floods destroy homes, trap families in cyclone-hit Mozambique
Reuters   (04/28/2019)   Mike Hutchings
[Editor’s note: Read the UN statementexternal icon on the flooding.]


Pakistan: Pakistani vaccine teams confront violence, hysteria in polio battleexternal icon
France 24   (04/26/2019)


St. Lucia: Scientology cruise ship leaves St. Lucia after measles quarantineexternal icon
Reuters   (05/02/2019)   Brendan O’Brien and Rich McKay


Tunisia: Tunisia invokes sharia law in bid to shut down LGBT rights groupexternal icon
The Guardian   (04/30/2019)   Saeed Kamali Dehghan


Uganda: Uganda simulates Ebola outbreak and identifies gaps in preparedness and responseexternal icon
World Health Organization   (04/24/2019)


Global: U.N. issues urgent warning on the growing peril of drug-resistant infectionsexternal icon
The New York Times   (04/29/2019)   Andrew Jacobs
[Editor’s note: Read the UN warningexternal icon.]

Profile in Public Health Law: Elva Yañez
Photo: Elva Yañez, Director of Healthy Equity, Prevention Institute

Title: Director of Healthy Equity, Prevention Institute

Education: MS, University of Southern California, School of Library and Information Management


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

Yañez: I was 12 years old when my sister took me to a civil rights rally in downtown Los Angeles. It had a powerful impact on me and led to my involvement in social change movements. I got my start in public health working as a research librarian in Berkeley, California, in the 1980s.

I transitioned into full-time policy advocacy work after working on the campaign to enact a precedent-setting liquor store zoning ordinance in Oakland, California, in the early 1990s. I subsequently spent about a decade in tobacco control, much of it helping cities throughout the United States enact local smoke-free ordinances.

Since 2004, after getting involved as a volunteer in a grassroots land use campaign in my Los Angeles neighborhood, my career has focused extensively on environmental health and environmental justice issues, including park equity for underserved communities.

PHLN: What is the Prevention Institute?

Yañez: Prevention Institute (PI for short) is a national nonprofit that works to achieve health, safety, and well-being for everyone by focusing on health equity and on creating the community conditions that will prevent people from becoming ill or injured in the first place. We’ve been in existence for more than 20 years and have offices in Oakland, Los Angeles, Houston, and Washington, DC. We partner with communities, local government agencies, foundations, different sectors, and public health agencies to bring cutting-edge research, practice, strategy, and analysis to the pressing health and safety concerns of the day. We’ve applied our approach to injury and violence prevention, healthy eating and active living, land use, health system transformation, and mental health and well-being, among other issues.

PHLN: What is your role at the Prevention Institute?

Yañez: As director of health equity, I ensure that health equity is integrated across our national efforts and embedded in the organization’s core strategic directions and program areas. On a day-to-day basis, my health equity work focuses on policy and systems change related to land use, environmental health, and environmental justice issues, ranging from parks and open space to stormwater quality. I work out of our Los Angeles office, which serves as an important living laboratory where we test new prevention strategies and models before we elevate them nationally. For example, we managed an innovative community engagement project for Los Angeles County’s Safe, Clean Water program. I also facilitate the Healthy, Equitable, Active Land Use Networkexternal icon to promote land use policies and practices that support health equity in the Los Angeles region.

PHLN: Much of your work focuses on the relationship between land use and public health. Can you talk about why access to parks is important for public health?

Yañez: We now have a lot of evidence showing that parks, trails, community gardens, and other urban green spaces are fundamental to creating healthy, vibrant communities. They provide social, health, environmental, and economic benefits. For example, people who live within walking distance of parks are three times more likely to meet recommended levels of physical activity than those who live beyond walking distance. In terms of mental well-being, research shows that proximity to parks and natural spaces provides respite and stress relief from the pressures of urban life, lengthen the lifespan, and improve people’s moods and sense of well-being.

Parks also provide lots of benefits for young people—they enhance child development and help protect children from preventable chronic diseases, and they prevent youth crime, aggression, and violence. And they provide important environmental benefits like regulating air temperature, reducing air pollution and greenhouse gas emissions, dampening noise, capturing stormwater runoff, and protecting habitats for urban wildlife.

PHLN: What does it mean to be “park poor”?

Yañez: The typical park and recreation agency offers 10 acres of parkland per 1,000 residents; another metric for optimal park access is that everyone should have a park within a 10-minute walk from home. While parks, playgrounds, recreation centers, and open space are fundamental building blocks for healthy, vibrant communities, not all communities have safe access to these places. Generally speaking, a park poor community has far less parkland in comparison to other areas within a jurisdiction, as well as fewer or poor-quality recreational facilities and programs. These deficits or inequities are disproportionately found in low-income communities of color, which are also more likely to experience higher rates of chronic illness associated with physical inactivity, including type 2 diabetes, cardiovascular disease, and childhood obesity.

PHLN: How does a community become park poor?

Yañez: Policies that advanced racial injustice, including segregation and discriminatory planning, zoning, and real estate practices, have been the historic drivers of resource and infrastructure inequities in urban low-income communities of color. These inequities date back to Jim Crow laws, biased home loans, redlining, and exclusionary zoning, among other policies and practices.

Even as formal desegregation advanced in cities across the country, new barriers to equal access to parks emerged, including disinvestment in the urban core, closures, and privatization, among others. For example, in the early 1960s, several Southern cities chose to slash funding for or close down parks and recreation facilities rather than integrate them. It’s important to note that these discriminatory practices were not limited to the Deep South but were commonplace throughout the United States. In Los Angeles, public recreation facilities such as swimming pools were not integrated until the 1950s and, in some cases, the 1960s. The legacy of these decisions continues to play out today.

State and local policies, practices, and procedures have also played a role in denying some communities safe and easy access to parks, open space, and recreational amenities and the benefits they confer.

PHLN: What is the role of public finance in increasing access to parks?

Yañez: While the most effective way to close historic gaps in park infrastructure requires funding, most jurisdictions have been cutting, not increasing, park and recreation budgets since the 1960s. That’s where public finance measures come in. Traditional public finance tools like bonds and assessments are well established mechanisms to increase funding for parks, open space, and recreation services and have been used in a number of jurisdictions throughout the United States in the absence of more fundamental fiscal solutions to funding parks and other municipal services. These tools can also be used to explicitly eliminate park inequities.

Here in Los Angeles, advocates have pushed for equity provisions in park finance measures, and elected officials have responded by including language that intentionally sets aside revenue to prioritize park projects in areas of high need—that is, areas that are park poor. Without such guarantees and clear criteria for where competitive grant funds should go, the status quo prevails, and these funds oftentimes end up going to projects in well-resourced communities that already have their fair share of parks, instead of the communities that need them most.

PHLN: Recently, the Los Angeles County Board of Supervisors voted on grant-making programs for the Safe, Clean Neighborhood Parks and Beaches Measure of 2016, allocating 30% of competitive funds to higher-need areas. What are the challenges for effective implementation of this policy?

Yañez: We had a really exciting victory in Los Angeles County recently, but it took several years to get there. In 2016, county voters overwhelmingly approved ballot Measure A, the Safe, Clean Neighborhood Parks and Beaches Measure. Measure A is expected to generate $92 million for parks and green spaces per year in perpetuityfrom a countywide parcel tax. As part of the measure’s expenditure plan, 13% of the overall revenue generated was set aside, off the top, for high park-need areas.

The recent action by the Board of Supervisors made decisions about the competitive grant-making portion of Measure A revenue. As you mentioned in your question, 30% of that funding will be dedicated to park projects located inpark-poor neighborhoods, which in Los Angeles County are predominately low-income, black, and Latino neighborhoods. All told, approximately $22 million of Measure A revenue will be dedicated to eliminating park inequities annually.

Self-interest—in this case, on a regional and organizational level—was a fundamental obstacle to achieving equity in developing Measure A’s competitive grant-making policies and procedures. Some communities saw themselves as “losing out” as a result of the 30% equity set-aside and tried to find ways to ensure their interests were met. For example, efforts were made to ensure that parks in low-need areas that serve residents from high-need areas were eligible for project funding from the equity set-aside. There were other shenanigans that we had to deal with as well. But at the end the day, the park equity advocates convinced the Los Angeles County Board of Supervisors to enact funding guidelines that directed a significant portion of Measure A funding to where it was needed most. These guidelines were just approved on March 5.

What we’ve learned through this process is how important it is to intentionally “bake” equity into all aspects of policies and procedures designed to reverse inequities. While some folks were willing to promote equity to mobilize voters from high park-need areas, their commitment to equity faltered when the actual funding guidelines were being hammered out. This means that equity has to be elevated from the development of the measure’s expenditure plan to its placement on the ballot, to the development of implementation guidelines, to the oversight and evaluation of funding decisions.

PHLN: How important is community engagement in driving policy change in this area?

Yañez: I don’t think we would have achieved the victory we did in Los Angeles without community engagement and community organizing. Both are essential to achieving equity in policy initiatives. People in neighborhoods without parks or whose parks don’t have services know what they’ve been denied. But they traditionally haven’t had opportunities to make their needs known through a process like the countywide parks needs assessment or through community-based organizations ready to take a strong policy advocacy leadership role alongside them in this kind of funding measure.

As part of the parks needs assessment process, Prevention Institute worked with advocacy groups, park development organizations, and grassroots organizations that operate in high park-need communities to build residents’ policy advocacy capacity and mobilize them for a process that lasted over two years—from countywide park needs assessment, to the passage of the original ballot measure, and through adoption of the implementation guidelines. The seeds for a Park Equity Alliance were planted during the countywide needs-assessment process, which drew in these organizations to fight for the original 13% set-aside in the expenditure plan; it took even greater shape as the implementation process unfolded.

PHLN: What are some innovative tools communities have used to increase access to public parks?

Yañez: It is important to recognize the distinctions between efforts to increase access by government agencies and those by community-based organizations and the residents they work with. Agencies tend to focus on increased and enhanced outreach, engagement, and programming, which, when done well, can be very effective.

Nonprofit, community-based land trusts are another innovative strategy in park development work that can be tailored specifically to reversing park inequities in low-income communities of color. They deeply involve residents in the design, development, maintenance, and operations of smaller neighborhood-level parks, playgrounds, skate parks, and community gardens.

To eliminate or reverse the structural barriers to improved access to parks and open space in high-need communities, I believe that the key innovations are related to community-driven policy advocacy action. This strategy depends on private philanthropy recognizing the importance of park equity advocacy and providing funding for community organizing and other policy advocacy actions by community groups.

PI’s approach to improving park access reflects our belief that equitable community transformation comes from investing in and building community-based capacity, leadership, and organizational infrastructure required for policy, systems, and environmental change.

PHLN: Prevention Institute is based in California, but lack of access to parks is not unique to California. What kind of assistance has Prevention Institute offered in other jurisdictions?

Yañez: Prevention Institute is a national organization that works with communities across the country on a range of topics, including mental well-being, community safety, access to healthy food and physical activity environments, and health system transformation. However, our park equity advocacy work has been concentrated in California.

The health field has just recently evolved to embrace parks as a public health issue. Our work—integrating the art and science of health equity with policy advocacy into a unified strategy to address the systemic roots of park inequity—is really pushing a boundary. That’s why we think it is so important to share these victories. We are really looking forward to opportunities to work with other jurisdictions in a more systematic way both to share what we’ve accomplished and learn from others. I was recently part of a delegation to Seattle, King County, Washington to share our experiences with them as they work to advance park equity. I believe there is so much we can learn by working across the country.

PHLN: What advice would you offer community members and policy makers who would like to improve access to public parks?

Yañez: Beyond elevating the role of community-based organizations as key players in policy change to improve access to parks, here are some suggestions.

For policy makers: Know that parks, playgrounds, and open space are very personal and important resources for children and families. They may not be the public resources people are most vocal about right off the bat, but when an opportunity exists for constituents to talk about the importance of parks and open space, a lot of very personal and meaningful experiences will emerge.

People of all races and income levels care deeply about safe, clean, well-maintained parks and recreation opportunities within walking distance of their work and homes.

For community members: Connect with organizations and local policy makers to share your personal stories about how parks and playgrounds have played an important role in your life. The voices of residents are very powerful when directed at ensuring equitable access to parks and open spaces. Also, don’t be afraid to ask where money is being spent to plan, build, and operate and maintain parks. That information should be available to the public, and it provides a useful indicator not only for understanding inequities but also for making the case for where funds should be directed to improve park access.

PHLN: Do you have any hobbies?

Yañez: I love to go hiking in the open space area behind my house. Through grassroots organizing, I led an effort to save one of the few remaining undeveloped, open space areas in Northeast Los Angeles, so walking there has a very deep and personal meaning for me. We can’t take parks and open space for granted or assume they’ll always be there for future generations unless we’re vigilant.

Public Health Law News Quiz

The first reader to correctly answer the quiz question will be featured in a mini public health law profile in the June 2019 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 2019

Which international organization has issued a warning about the growing issue of drug-resistant infections?

April 2019 Quiz Winner
Photo: Karissa Loper

Karissa Loper

April Question: PHLP published a LawAtlas map and legal epidemiology dataset on what topic related to dogs, cats, and ferrets?

Winning Answer: Rabies vaccinationexternal icon

Employment organization and job title: Deputy Bureau Chief, Bureau of Child, Family and Community Wellness, Nevada Division of Public and Behavioral Health

A brief explanation of your job: I assist in conducting administrative oversight of four health sections that make up the bureau: Immunizations; Chronic Disease Prevention and Health Promotion; Maternal, Child and Adolescent Health; and Nevada’s Women, Infant and Children (WIC) Program. I do it all—HR; budget preparation and expense reviews; promulgating regulations under the division’s authority; applying for continuing and new funding opportunities; designing, implementing, and evaluating public health programs, etc. The bureau chief and I act as the liaison between staff on the ground implementing activities and division and Nevada Department of Health and Human Services leadership, the Nevada governor’s office, and Nevada’s legislators.

Education: BS in business administration with minors in accounting and economics, MPH with an emphasis in healthcare administration and policy, University of Nevada, Reno.

Favorite section of the Public Health Law News:“Profile in Public Health Law,” because I love reading how people use their education and experience to work in public health law and to learn how what they do helps improve the health of their community or the nation.

Why are you interested in public health law? I had dreams of becoming a lawyer and working in healthcare/public health law, but life has had other plans for me in Nevada. As a state public health professional, it is still important to me to be current on relevant public health law research and news, because it can help me inform leadership of impending issues and/or novel solutions that may impact Nevada. And, I just like to be informed about the law.

What is your favorite hobby? Reading for leisure; my favorite author is Stephen King.

Court Opinions

Alabama: Gasp, Inc. is a 501(c)(3) nonprofit health advocacy organization with a mission to advance healthy air and environmental justice in Birmingham, Alabama. Gasp’s suit challenged the authority of the Jefferson County Alabama Board of Health (“the Board”) to amend its rules under the Alabama Air Pollution Control Act of 1971. The Alabama Supreme Court found that the Air Pollution Control Act did not preempt the Alabama Administrative Procedures Act (AAPA), but said that the Board was not an “agency” pursuant to the AAPA and was, therefore, not subject to its procedural requirements. The Alabama Supreme Court affirmed the lower court’s dismissal.

Gasp v. Jefferson County Board of Health et al.external icon
Supreme Court of Alabama
Case No. 1171082
Filed 04/05/2019
Opinion by Justice Brady E. Mendheim


California: California’s Department of Public Health, AIDS Office (CDPH-AO) oversees the AIDS Drug Assistance Program, which serves underinsured or uninsured individuals living with HIV/AIDS in California. In 2016 CDPH-AO awarded a contract for managing enrollment benefits to A.J. Boggs and Company. Ramsell Corporation, a Boggs competitor, sued. Ramsell alleged that the lack of competitive bidding violated the state contracting manual or Budgeting Act of 2015 and sought to rescind the contract. CDPH-AO subsequently terminated the contract because of material breaches by Boggs. On the basis of this termination, the court granted CDPH-AO’s motion for judgment on the pleadings and found the termination of the Boggs contract rendered Ramsell’s complaint moot.

Ramsell Corporation v. State Department of Public Health, Office of AIDSexternal icon
Court of Appeals of California, Third District, Sacramento
Case No. C085548
Filed 04/08/2019
Opinion by Justice M. Kathleen Butz


Minnesota: This case arises out of an interaction between employees of two Minnesota health systems. A nurse practitioner in one system sought to have a patient admitted to the hospital of the other system. Admission was allegedly denied by a hospitalist. Three days later, the patient died. The patient’s son sued for malpractice, alleging that the hospitalist who denied the patient admission to the hospital was negligent and that the hospitalist’s negligence directly caused the patient’s death. The district court and a divided panel of the court of appeals concluded that, as a matter of law, the hospitalist owed no duty of care to the patient because no physician-patient relationship had been established. The patient’s son appealed to the Supreme Court of Minnesota. The court held that there is a legal duty of care based on the foreseeability of harm and that the harm was foreseeable by the hospitalist, based upon the facts alleged by the plaintiff. Whether the hospitalist was actually negligent is an issue of fact to be determined by a jury. The case was reversed and remanded to the district court for further proceedings.

Warren v. Dinterexternal icon
Supreme Court of Minnesota
Case No. A17-0555
Opinion by Justice David L. Lillehaug

Quote of the Month

“I see a lot of seriously mentally ill people on the street who are obviously having difficulty figuring out basic things. If I had lost my chance to be in a board-and-care home, if I’d become homeless, I think it would have been very difficult,” says Tristan Scremin of the arts-based mental health agency, Painted Brain.

[Editor’s note: This quote is from Overlooked mental health “catastrophe”: vanishing board-and-care-homes leave residents with few optionsexternal icon.
CALmatters   (04/15/2019)  Jocelyn Wiener

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