Public Health Law News

July 2019

Letter from the Editor

The Public Health Law Program would like to extend our warmest thanks to Diane Hawkins-Cox for her work on CDC’s Public Health Law News. Ms. Hawkins-Cox is the News’s primary copyeditor and has been an invaluable member of the team. During her tenure, she has improved the publication and been a tirelessly patient editor with a tremendous commitment to excellence. She has challenged and encouraged all of the authors she edited to write more clearly, precisely, and succinctly.

In addition to editing the News, Ms. Hawkins-Cox has worked for seven years on the Center for State, Tribal, Local, and Territorial Support’s entire suite of publications, including Did You Know?, Prevention Status Reports, Public Health Practice Stories from the Field, Field Notes, and more. Previously, Ms. Hawkins-Cox worked in CDC’s Prevention Research Centers Program, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, where she wrote research project descriptions, feature stories, and scientific articles and produced video features. Before working at CDC, Ms. Hawkins-Cox was a senior producer at CNN in the Science and Technology Unit. In that role, she produced, wrote, and copy-edited in-house and in-the-field stories on technology, environment, science, space; produced science-tech-environment newsmagazines; and manned the CNN “Military Desk” during invasions of Afghanistan and Iraq and the CNN “Hurricane Desk” during Hurricanes Katrina, Ike, and Gustav.

She is a talented flutist and avid birdwatcher—both of which she hopes to pursue more of in her retirement.

We will miss her fiercely and wish her every joy in the next chapter of her life.

Abigail Ferrell
Editor in Chief
CDC’s Public Health Law News

Announcements

The 36th Annual National Tribal Health Conferenceexternal icon. The National Indian Health Board is hosting the 36th Annual National Tribal Health Conference September 16–19, 2019, in Temecula, California. The conference is focused on American Indian and Alaska Native health and policy. Various breakout sessions and several government consultation and listening sessions will be featured.


Data on Schools Offering LGBTQ-Inclusive Sex Education Curriculaexternal icon. Child Trends has released a publication that analyzes lesbian, gay, bisexual, transgender, and questioning sexual education curriculum and supplementary material data from 46 states. It finds that a majority of schools in 15 states and the District of Columbia reported offering inclusive education while less than half of the secondary schools in the other 31 states provide such educational materials.


Legal Epidemiology in Practice: Exploring Local Inclusionary Zoning Lawsexternal icon. Temple University’s Center for Public Health Law Research is hosting a webinar on Wednesday, August 7, 2019, at 1 pm to 2 pm (EDT), in collaboration with the CDC Public Health Law Program and ChangeLab Solutions. This webinar will focus on the Cook County, Illinois, Department of Public Health and the department’s legal epidemiology project on laws in 10 cities nationwide that address inclusionary zoning.


2019 Reclaiming Vacant Properties Conferenceexternal icon. The Center for Community Progress is hosting the only national conference focused on strategies to improve communities by revitalizing vacant, abandoned, and deteriorated properties. The conference will be held in Atlanta, Georgia, October 2–4, 2019. Registration is open, with an early bird rate available until August 30.

Legal Tools

Podcast: Gregory Sunshine on CDC’s Public Health Emergency Law Online Training Programexternal icon. The Journal of Public Health Management and Practicepresents an episode of its podcast, Public Health Perspectives, on public health emergency law. The training can be used by state, local, tribal, and territorial public health practitioners to learn more about public health emergency preparedness and response law.


The Policy Surveillance Programexternal icon. Temple University houses the Policy Surveillance Program, which offers an online eight-module learning library. The program also conducts monthly webinars at both the introductory and advanced levels to teach various policy surveillance techniques.

The Fifty Nifty!

Alabama: Tuscaloosa agencies add officers with mental health trainingexternal icon
Northwest Florida Daily News   Stefanie Taylor   (06/26/2019)


Alaska: “Dire” law enforcement crisis in rural Alaska prompts emergency declaration, new federal fundingexternal icon
Anchorage Daily News   Alex Demarban   (06/28/2019)
[Editor’s Note: Read about US Department of Justice emergency funding to address the public safety crisis in rural Alaskaexternal icon.]


Arizona: Arizona Medicaid patients can now get a Lyft to the doctorexternal icon
GEEK.com   Stephanie Mlot   (06/27/2019)


Arkansas: Arkansas school nurses now have access to overdose-reversal drugexternal icon
THV11   Jordan Howington   (06/25/2019)


California: San Francisco becomes first major U.S. city to ban e-cigarette sales to combat teen vapingexternal icon
The Washington Post   Rachel Siegel   (06/26/2019)
[Editor’s Note: Read the ordinanceexternal icon.]


Colorado: New vaping law in Colorado goes into effectexternal icon
Fox31   Emily Allen and Joe St. George   (07/01/2019)
[Editor’s Note: Read New law amends Colorado Clean Indoor Act to ban vaping indoorsexternal icon]


Connecticut: Gov. Ned Lamont just signed a sweeping family and medical leave law. How will it work?external icon
Hartford Courant   Daniela Altimari   (06/25/2019)
[Editor’s Note: Read the lawpdf icon[PDF – 308KB]external icon.]


Delaware: Larger employers to be required to remit Delaware child support payments electronicallyexternal icon
Delaware Health and Social Services   (06/26/2019)


Florida: Key Florida Republicans now say yes to clean needles for drug usersexternal icon
NPR   Sammy Mack   (06/27/2019)
[Editor’s Note: Read more about the lawexternal icon.]


Georgia: New laws take hold in Georgia; 2 stem from Savannah areaexternal icon
WSAV3   Martin Staunton   (07/01/2019)
[Editor’s Note: Learn more about “Mary & Elwyn’s Law”external icon and “Margie’s Law.”external icon]


Hawaii: Measure requires restaurants to offer healthy drink options as default choice for keiki mealsexternal icon
Hawaii Tribune-Herald   Stephanie Salmons   (06/27/2019)
[Editor’s Note: Read the measureexternal icon.]


Idaho: Idaho will now test all rape kits. It could lead to more convictions, trust of policeexternal icon
Idaho Statesman   Ruth Brown   (07/02/2019)
[Editor’s Note: Read the lawpdf icon[PDF – 64KB]external icon.]


Illinois: Program aims to get all Illinois children vaccinatedexternal icon
Patch.com   Shannon Antinori   (07/08/2019)
[Editor’s Note: Learn more about the programexternal icon.]


Indiana: Fighting fertility fraud: New state laws go after misuse of spermexternal icon
Stateline   Elaine S. Povich   (07/03/2019)


Iowa: Children’s mental health law takes effect; months of planning aheadexternal icon
Iowa Public Radio   Katarina Sostaric   (07/05/2019)


Kansas: Top Kansas court: Cities can raise age for buying tobaccoexternal icon
The Republic   John Hanna   (07/01/2019)


Kentucky: A Kentucky teen sued to attend school without a chickenpox vaccine. He just lost in court — again external icon
CNN   Hollie Silverman and Mirna Alsharif   (07/02/2019)


Louisiana: Louisiana homeowners hit by 2016 flood will receive aid soonexternal icon
AP   (07/08/2019)


Maine: Maine governor makes it official: Cannabis sales start in 2020external icon
The Associated Press   (06/28/2019)
[Editor’s Note: Read about the lawexternal icon.]


Maryland: Maryland Department of Health alerts residents of new tanning lawexternal icon
Local DVM   Jayla Jackson   (07/03/2019)
[Editor’s Note: Read the lawexternal icon.]


Massachusetts: Baker signs a delay of paid leave payroll tax into lawexternal icon
WBUR   Colin A. Young   (06/12/2019)


Michigan: More Michigan water systems could exceed lead limits: Here’s whyexternal icon
Detroit Free Press   (06/26/2019)
[Editor’s Note: Learn more about lead exposure guidelines.]


Minnesota: Campaign aims to reach all Minnesota drivers with info about new hands-free lawexternal icon
Star Tribune   Tim Harlow   (06/22/2019)
[Editor’s Note: Read more about the lawexternal icon.]


Mississippi: Meet Doug: Mental health patients like him are forced to cycle through revolving door of state hospitals and group homesexternal icon
Mississippi Today   Larrison Campbell   (06/20/2019)


Missouri: Breastfeeding suites to open at Lambert Airport in Augustexternal icon
St. Louis Post-Dispatch   Blythe Bernhard   (07/02/2019)
[Editor’s Note: Read the Friendly Airports for Mothers Actexternal icon.]


Montana: Montana insurers propose lower individual premiumsexternal icon
Montana Public Radio   Kevin Trevellyan   (06/27/2019)


Nebraska: To combat vaping, Nebraska school district will randomly test students for nicotineexternal icon
NBC News   Elizabeth Chuck   (06/18/2019)


Nevada: Nevada attorney general files Supreme Court brief to protect LGBTQ+ employees from discriminationexternal icon
Fox 5   Katherine Webster   (07/05/2019)


New Hampshire: New state law requiring more lead testing, remediation takes effectexternal icon
New Hampshire Public Radio   Annie Ropeik   (07/02/2019)
[Editor’s Note: Learn more about New Hampshire’s Healthy Homes and Lead Poisoning Prevention Programexternal icon.]


New Jersey: In a nationwide first, New Jersey authorizes paramedics to start addiction treatment at the scene of an overdoseexternal icon
STAT   Lev Facher   (06/26/2019)
[Editor’s Note: Read about the New Jersey Department of Health Commissioner’s authorization of paramedics to carry buprenorphineexternal icon.]


New Mexico: New Mexico postpones hearing on child care proposalexternal icon
KOB4   AP   (07/05/2019)


New York: NYS receives federal funding for Child and Adult Care Food Programexternal icon
[Editor’s Note: Read about New York’s Child and Adult Care Food Program, Promoting Health and Wellbeing for All New Yorkersexternal icon.]


North Carolina: New N.C. law paves way for uninsured to receive more donated medicationexternal icon
The Richmond County Daily Journal   (07/02/2019)
[Editor’s Note: Read about the lawexternal icon.]


North Dakota: North Dakota WIC program increases eligibility guidelinesexternal icon
Grand Forks Herald   (06/07/2019)
Editor’s Note: Read about North Dakota’s increased income levels for WIC program eligibilitypdf icon[PDF – 162KB]external icon.]


Ohio: Firework safety: What Ohio law says about fireworksexternal icon
WHIOTV7   Franchesca Hackworth   (07/03/2019)


Oklahoma: Oklahoma’s final witness in opioid trial rips into drugmaker Johnson & Johnsonexternal icon
CNN   Wayne Drash   (06/25/2019)


Oregon: New Oregon law ensures medical decisions can be made for adults with developmental disabilitiesexternal icon
The Oregonian   Mark Graves   (07/02/2019)
[Editor’s Note: Read the lawexternal icon.]


Pennsylvania: Pennsylvania starts automatic sealing of some criminal filesexternal icon
Pittsburg’s Action News 4   (06/28/2019)
[Editor’s Note: Read the lawexternal icon.]


Rhode Island: Cashless business ban becomes Rhode Island lawexternal icon
Patch   Rachel Nunes   (07/01/2019)
[Editor’s Note: Read the lawpdf icon[PDF – 10KB]external icon.]


South Carolina: SC’s Raise the Age law is about to go into effect. How it will be implemented remains vague.external icon
The Post and Courier   Michael Majchrowicz   (06/25/2019)
[Editor’s Note: Read the lawexternal icon.]


South Dakota: E-cigarettes included in state smoke-free law starting July 1external icon
Patch   (07/01/2019)
[Editor’s Note: Read the amendmentexternal icon.]


Tennessee: Supreme Court strikes down Tennessee liquor sales law in win for big retailersexternal icon
ABC   Devin Dwyer   (06/26/2019)


Texas: Construction begins on first public mental health hospital in Harris County in more than 30 yearsexternal icon
Houston Chronicle   Natalie Weber   (06/26/2019)


Utah: DUI crashes down in first quarter with Utah’s strict .05% lawexternal icon
Deseret News   Pat Reavy   (07/06/2019)
[Editor’s Note: Read the lawexternal icon.]


Vermont: Vermont Leverages 92% Tax on Vapingexternal icon
Daily Caller   Kyle Hooten   (07/02/2019)
[Editor’s Note: Learn about Vermont’s new vape and tobacco legislationpdf icon[PDF – 138KB]external icon.


Virginia: Teens of ‘anti-vaxxers’ can get their own vaccines, some states sayexternal icon
Stateline   Michael Ollove   (06/24/2019)


Washington: Washington state surprise-billing law takes effect at end of monthexternal icon
Becker’s Hospital Review   Kelly Gooch   (07/01/2019)


West Virginia: West Virginia will now provide free community college tuition if students can pass a drug testexternal icon
Pacific Standard   Kelley Czajka   (07/01/2019)


Wisconsin: La Crosse could be next community to restrict online alcohol salesexternal icon
Wisconsin Public Radio   John Davis   (06/28/2019)


Wyoming: Dozens of new laws in Wyoming took effect Monday. How are you affected?external icon
Casper Star Tribune   Nick Reynolds   (07/01/2019)


District of Columbia: New laws taking effect July 1, 2019 in DCexternal icon
Patch   Dan Taylor   (07/01/2019)


American Samoa: Lolo requests the USDA to ‘expedite’ release of $18M for nutrition assistanceexternal icon
Relief Web   (07/07/2019)


Guam: Bill targets chemicals in drinking waterexternal icon
The Guam Daily Post   Oyaol Ngirairikl   (07/01/2019)


Commonwealth of the Northern Mariana Islands: $15 minimum wage debateexternal icon
Saipan Tribune   John S. Del Rosario, Jr.   (07/12/2019)


Puerto Rico: Despite new law, Trump administration has not given Puerto Rico emergency food stamp aidexternal icon
The Washington Post   Jeff Stein and Arelis R. Hernández   (06/24/2019)


United States Virgin Islands: Senators OK landmark toxic sunscreen banexternal icon
The Virgin Islands Daily News   A.J. Rao   (06/26/2019)


Tribal: Federal and tribal coalitions challenge Canadian miningexternal icon
High Country News   Liz Weber   (07/08/2019)

Profile in Public Health Law: Irina Gelman
Photo: Irina Gelman

Title: Commissioner of Health, Orange County (NY) Department of Health

Education: DPM, New York College of Podiatric Medicine; MPH, Nova Southeastern University College of Osteopathic Medicine; PhD (candidate), Walden University


Public Health Law News (PHLN):Please describe your career path and what drew you to public health in a county health department setting.

Gelman:My father was diagnosed with early-onset diabetes mellitus type II when I was five years of age, and that prompted me to follow my lifelong dream of becoming a doctor. My family witnessed the consequences of this chronic disease as my father’s health declined over the next decade. The disease progressed, and he became insulin dependent then went on to weekly dialysis treatments.

During my second year of residency program training, upon completing the Master of Public Health program at the Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale, Florida, my career path became apparent with my increasing interest in US healthcare system reform, population health, and community health initiatives. Unfortunately, during this time, we watched my father’s health further deteriorate, leading to kidney failure. My father was blessed to receive a kidney transplant, and his ordeal inspired me to pursue public health.

After a tragic fall resulted in the failure of my father’s transplanted kidney, he passed away in February of 2016. There is not a day that goes by that I don’t think of him, as he inspires me to work harder in pursuit of more effective public health outreach, education, and prevention measures.

PHLN:Please tell us about your role in the Orange County Department of Health.

Gelman:As the commissioner of health, I am directly responsible for all facets of operation of our health department and am fortunate to have a wonderful team of dedicated public health professionals who care about the residents of the community we serve. The Orange County Department of Health team is responsible for preventing and responding to epidemics and the spread of disease, protecting against environmental hazards, promoting healthy lifestyles, helping our community respond to disasters, and working with community partners to ensure access to high quality health services. My role entails providing direct leadership and legal health authority for all local public health policies that address the healthcare needs of diverse communities, as well as dealing with emerging and complex health issues such as bioterrorism preparedness, epidemics, planning for pandemic influenza, integrating health equity while accounting for the social determinants of health, and addressing the surge in chronic conditions such as diabetes, obesity, and asthma.

PHLN:What are the most prevalent public health issues in Orange County?

Gelman:The public health issues in Orange County are similar to those in other counties within New York State, as well as the rest of the nation. Currently, we are in the midst of a measles outbreak. The ongoing opioid epidemic remains a top priority. We are also constantly monitoring vector-borne diseases and sexually transmitted infections, along with other reportable communicable diseases. At the forefront are issues pertaining to substance abuse, smoking/vaping cessation, and chronic diseases (diabetes mellitus, hypertension, obesity, cardiovascular, asthma, etc.). Environmental health issues such as lead poisoning in children, water quality, and summer camp safety have always been, and remain, a top priority.

PHLN:How is the health department tackling these issues?

Gelman:The health department team members must have the mental acuity and fiscal agility to tackle increasing population health issues and a growing number of unfunded mandates, all with an ever-shrinking budget. With the guidance of our county executive, legislative health committee, and the board of health, the Orange County Department of Health remains the lynchpin of the county’s public health education, environmental safety, disease prevention, and population health outreach efforts. The health department maintains the facilitator role in convening pertinent stakeholders and partners for community health assessments and community health improvement plans, as well as new public health initiatives. The health department delivers epidemiologic surveillance of reportable, communicable diseases; chronic conditions; vector-borne diseases; and sexually transmitted infections along with other health indicators. The Orange County Department of Health team incorporates evidence-based approaches into continuing guidance for health across all policies, as well as outreach education and prevention services aimed at improving the health outcomes and metrics of our residents. Our health department participates in emergency preparedness response, drills, and planning.

Our nursing division provides point of dispensing and emergency response to disease outbreaks for all county residents, as necessary. The nursing division holds regularly scheduled clinics for screening and treating tuberculosis and sexually transmitted infections (including HIV), travel, immunization, and other conditions in the uninsured and underinsured population. Our health department provides early childhood development services; environmental inspections, permitting and approval of summer camps and food establishments; water systems safety sampling, testing, and review; and services of the medical examiner division. Of note are our health equity division efforts concentrated on incorporating social determinants of health in programs aimed at addressing the needs of women, migrant workers, specialty demographics, and minority populations, with the intent of reaching all of the residents of our county.

PHLN:Before living in Orange County, you lived in and were the director of public health for Fulton County, New York. Generally, how were the public health issues different from those in Orange County, New York?

Gelman:Similar public health issues, simply a different scale. Fulton County, New York, is the fifth most populous county in the Adirondack Rural Health Network, with a total population of more than 55,000 (with half residing in urban and half in rural areas). The poverty rate and level of educational attainment strongly influence community health outcomes. There were significant access-to-care issues in Fulton County, as outlined in the priorities of its community health needs assessment.

The rate of age-adjusted preventable hospitalizations was higher than in other parts of Upstate New York, as well as higher than the Prevention Agenda benchmark. The rate of emergency department visits in Fulton County was more than double the Upstate New York rate. The percentages of adults with poor physical health and physical limitations both were higher than the percentages for our Upstate New York neighboring counties. Obesity and smoking rates in Fulton County were substantially higher than rates in the contiguous counties and in New York State as a whole, resulting in increased incidence of COPD, asthma, and lung disease. The rates of cardiovascular diseases of the heart, coronary heart disease, and congestive heart failure deaths and hospitalizations were all higher than their correlating rates for Upstate New York. The rates of stroke deaths and hospitalizations were also higher than the remainder of Upstate New York. According to 2016 data from the US Department of Health and Human Services Health Resources and Services Administration, Fulton County is considered to be a Health Professional Shortage Area for primary care, mental health, and dental care.

The fact is residents in rural geographic areas have limited access to healthcare, resulting in poor health outcomes. Residents in rural geographic areas in New York State face a unique set of challenges and healthcare needs. Navigating the healthcare landscape is challenging at times, and the low population density in relation to proximity and availability of healthcare providers in the region exacerbates health disparities.

PHLN:How did the issues in Fulton County affect you personally, and how did your personal experiences reveal larger problems with the public health infrastructure in that area?

Gelman:When my family and I relocated to Johnstown, New York, finding a primary care provider was difficult, as most practices did not accept new patients at the time, and/or would not schedule appointments for months out. The majority of medical providers worked Monday through Friday, typically between 8 am and 4 pm, coinciding with work and school hours. So residents would have fewer preventive visits and irregular annual checkups, and they would present later in the progression of chronic disease and/or with a more severe acute condition.

PHLN:What is telehealth?

Gelman:The Health Resources and Services Administration defines telehealth as “the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the Internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.” Telehealth is the overarching concept that incorporates health education and outreach while including telemedicine and telemetry components, encompassing remote consultations with a doctor, as well as vital sign monitoring that records and reports the information to a provider.

PHLN:How can telehealth be used as a tool to improve population health?

Gelman:Telehealth could provide a viable solution to the increased need for remote access to care. The benefits of telehealth include evidence-based cost and time effectiveness. And research on existing telehealth systems shows it could have a major impact on overall health outcomes and population health. The various populations mentioned in research span a multitude of demographics and socio-economic determinants. Research highlights the tremendous benefit of telehealth initiatives in rural settings, along with the potential for transforming the realm of healthcare by reducing delivery costs and increasing access to and quality of care.

The power of partnerships and importance of health equity integration cannot be emphasized enough, and a virtual access platform for telehealth may be the conduit to that. Multisectoral community coalitions may leverage existing resources while optimizing current healthcare provision models by virtually connecting correlating services with residents in need of care.

Comprehensive communitywide telehealth initiatives may enhance access to care by offering remote access alternatives to residents. They could also expand virtual access options for disease surveillance, treatment monitoring, meetings for service plan improvement and delivery, public health emergency preparedness and emergency response, and other applications. This innovative approach includes the integration of public health education and prevention.

PHLN:How did your health department go about setting up a telehealth program in Fulton County?

Gelman:The Fulton County Public Health Department team worked closely with the amazing information technology director Perry Lovell and his staff; Fulton Montgomery Community College students; safety officers and instructors lead by Dustin Swanger; with Andrea Fettinger, director of the Office for the Aging and Youth; and of course the Fulton County administrator, all of whom full-heartedly supported this initiative and have proven to be true visionaries.In collaboration with community stakeholders and with the approval of the Fulton County Board of Supervisors, the initial wave of Medicaid restructuring engagement funding was used to set up health stations at the Public Safety Office of the Fulton Montgomery Community College, Fulton County Office for the Aging and Youth, and the Fulton County Public Health Department. An encrypted HIPAA/ FERPA compliant platform was used to connect county residents to a healthcare provider at the two local hospitals or any other provider of their choice.

We have expanded this telehealth initiative countywide. The expansion is intended to help integrate equity as an underlying element of all strategies aiming to improve health and reduce the burden of chronic diseases through evidence- and practice-based strategies. It is also intended to help create and strengthen healthy environments that make it easier for people to make healthy choices and take charge of their health.

PHLN:What challenges did you face when setting up the telehealth program? How did your health department and community overcome these challenges?

Gelman:When we first set out on the quest, New York State had no telehealth parity laws for practice and reimbursement. Hence, there was hesitancy on the part of our community stakeholders and apprehension from healthcare providers. Furthermore, a number of competing, disjointed remote access platforms were offered in the area by insurance companies, concierge doctor-on-demand applications, employers, etc. The current race to privatize, monopolize, and capitalize on telemedicine services creates an environment for personal and corporate financial gains, thereby diminishing the efficacy of public health applications.

Unlike concierge doctor platforms available commercially, this initiative preserves continuity of care through employers and/or medical insurance companies. Patients are not treated in a virtual vacuum and are seen by local providers with access to their electronic medical records, and any complications may be uninterruptedly addressed in a brick and mortar clinical setting. Providers can manage their patients virtually, navigating patients to a healthcare setting ideal for their condition, thereby inadvertently making room for new patients while evaluating frequent visitors remotely.

PHLN:What role did law play in Fulton County’s access-to-care issues? Has law been a tool for mitigating these issues? If so, how?

Gelman:The New York State telehealth parity law went into effect on January 1, 2016, making New York the 22nd state to pass telehealth parity legislation. This required commercial insurers and the Medicaid program to reimburse for services delivered via telehealth if those services would have been covered if delivered in person. However, to receive Medicaid reimbursement, the following requirements had to be met: qualified telehealth providers had to be licensed in New York State and enrolled in the state Medicaid program, the “originating site” and the “distant site” for a telemedicine encounter had be staffed, and there had to be a preexisting relationship with the service recipient.

Although these caveats had to be met to qualify for Medicaid reimbursement, the same limitations did not exist for providing telehealth services and integrating remote access services into public health education, outreach, and prevention initiatives. Nonetheless, we learned that most medical care providers were very set in the ways of the fee-for-service reimbursement structure and failed to see the utility of a comprehensive local virtual access-to care-model. Law has been a viable tool for mitigating these issues, in more than one way. The Care Veterans Deserve Act of 2017 allowed a licensed healthcare professional to practice using telemedicine in any state under the VA program.

PHLN:How did your office address data privacy issues related to telehealth?

Gelman:The system uses a ubiquitous, encrypted HIPAA/ FERPA compliant platform to connect our county residents in real time—not  “store and forward”—to a healthcare provider at the local hospitals or any other provider of their choice. The server is housed with the Fulton County IT Department for neutrality and added security. The health stations are set up in rooms with no windows, as privacy is a major consideration.

The platform does not require the entry of any personal identifiers, no health or personal data is exchanged, the encounter is not recorded, and no information is stored. Since the platform is compatible with all electronic medical records programs already used by the healthcare organizations, the providers populate their own templates and access their existing records, thereby assuring continuity of care and the highest standards of care delivery. This was never intended to be a diagnostic and treatment platform—more of a real-time navigation and access-to-care program—hence, the platform doesn’t store any records or process any data. Single-use earbuds are provided at the virtual health stations for those who do not have their own, for added privacy.

Many attorneys, some representing various participating entities, collaborated on the terms of use, which include the patient rights and responsibilities, HIPAA disclaimer, notice of privacy, and the hybridization with other pertinent forms, waivers, and disclaimers. The terms of use have to be agreed upon to proceed to the virtual waiting room and be able to use the telehealth program. Since the terms of use are lengthy, resembling Leo Tolstoy’s War and Peace, a laminated copy is made accessible at each health station, and an electronic version is available via electronic mail or phone call, upon request.

PHLN:What advice would you give other communities who are interested in implementing telehealth?

Gelman:The Fulton County telehealth initiative is the first program to include the integration of public health education and prevention in the expanded access-to-care model, providing an innovative approach to population health efforts. As a governmental agency, we have collaborated with an array of stakeholders including businesses, schools, nonprofit organizations, healthcare organizations, community planning agencies, local housing authorities, social service agencies, civic organizations, faith-based institutions, and other community-based organizations. This population health initiative is viable, easily reproducible, fiscally responsible, and sustainable long-term; would provide a positive public health impact in any region; and is the quintessential primary prevention strategy.

PHLN:How have you applied some of your experiences from Fulton County to your new role in Orange County?

Gelman:With enthusiasm, we are currently exploring the possibility of telehealth integration across a multitude of sectors within Orange County, while concurrently examining the utility of such platforms. We look forward to more robust discussion on this topic with community partners in the upcoming months. The countywide telehealth applications are endless, and the initiative is relatively simple to implement and is fiscally responsible to consider.

PHLN:Have you read any good books lately?

Gelman:Yes, besides many favorite cookbooks; various books about chocolate; board examination reference workbooks, school textbooks, and numerous psychology books; other than the coffee table art/sculpture/photography books about the works of Ron Mueck, Tatsuya Tanaka, and local artist Ruby Silvious; a few recent favorites: Law in Public Health Practiceby Richard A. Goodman, The Selfish Geneby Richard Dawkins, The Checklist Manifesto: How to Get Things Rightby Atul Gawande.

PHLN:Do you have any hobbies?

Gelman:A distinct passion for hosting, cooking, scientific and technological advances, classical music, outdoor activities, population health improvement, and community service.

PHLN:Is there anything else you would like to add?

Gelman:Yes, to learn more about the Fulton County, New York, countywide telehealth initiative, please view my TEDx talk, Innovation in Healthcare. As a proponent of domestic manufacturing, ethical supply chains, population/community health, telehealth technologies, and public health education efforts, I would like to remind everyone to shop local, feel national, think global, and make a difference!

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 August 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 NewsQuiz Question July 2019

Which state now requires that children’s meals come with a healthier default drink choice?

June 2019 Quiz Winner
Photo: Richard Dorritie

Richard Dorritie


June Question:

What fraction of roads owned by the Bureau of Indian Affairs are unpaved, making it difficult for children to get to school during the winter and monsoon months?

Winning Answer: ¾ of roads

Employment organization and job title: Helene Fuld College of Nursing, Associate Professor of Nursing and Director of the Associate Degree in Nursing program.

A brief explanation of your job: I recently accepted the above position educating the next generation of nurses and leaders.

Education: Recently defended my PhD in nursing at Columbia University School of Nursing; BS Nursing at Hunter-Bellevue; AAS Nursing at Borough of Manhattan Community College.

Favorite section of the Public Health Law News: Profile in Public Health Law. I have always been interested in the people behind the story—the motivation, the lives, the dreams that I can connect with and draw inspiration from. 

Why are you interested in public health law? As a nurse (and human) I feel my mission is to work for social justice. I am focused on the health inequities caused by poverty, understanding that poverty is a societal issue, created by law/policy. I need to know and understand public health law in order to further my future research, using legal epidemiology methods to examine policy that can reverse or cause poverty and its sequalae. Additionally, I need to understand the legal landscape in order to help educate nurses to take on leadership and governance rolls as policy makers, advocating for healthier living conditions.

What is your favorite hobby? Traveling the world (or neighborhood) with my wife and making and drinking cappuccinos.

Court Opinions

Delaware: In 2015, Blue Bell Creameries USA’s ice cream was contaminated with listeria. The contamination lead to the death of three people, and as a result, the company faced significant economic hardship, laying off more than a third of its employees. The shareholders sued the president, vice president, and directors of the company, claiming the executives breached their duty of loyalty by disregarding contamination risks. The Supreme Court of Delaware found that the directors did not have adequate systems in place to prevent an outbreak and had no mechanisms to respond to listeria contamination risks. The court relied on multiple public health citations the company received. The case was remanded to a lower court to determine fault.

Marchand v. Barnhillexternal icon
Supreme Court of Delaware
Case No. 533, 2018
Decided 06/18/2019 and Corrected 06/19/2019
Opinion by Chief Justice Leo E. Strine, Jr.


Federal: Uranium mining has been illegal in Virginia since the 1970s because of the potential health hazards associated with uranium mining. Virginia Uranium challenged the prohibition on the basis that the Atomic Energy Act allows the Nuclear Regulatory Commission (NRC) to regulate all forms of the uranium fuel cycle, and therefore a state does not have the authority to ban mining. The Supreme Court of the United States in a 6–3 decision ruled that the Atomic Energy Act gives the NRC ability to regulate everything regarding nuclear fuel except mining. The justices interpreted the act to mean Congress did not intend to take the power away from the states regarding uranium mining and upheld Virginia’s law banning uranium mining in the Virginia Commonwealth.

Virginia Uranium, Inc. v. Warrenexternal icon
Supreme Court of the United States
Case No. 16-1275
Decided 06/17/2019
Opinion by Justice Neil Gorsuch

Quote of the Month

“With more than 1 million uninsured people and many more under-insured in North Carolina, we felt a need to make this change to reduce the number of medications that are simply discarded and help many more people who can’t afford medications they need. This is a great example of a bipartisan effort to make a common-sense change to better serve our medically needy population.” North Carolina State Representative Wayne Sasser

[Editor’s Note: This quote is from New N.C. law paves way for uninsured to receive more donated medicationexternal icon  The Richmond County Daily Journal   (07/02/2019)]

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Page last reviewed: July 18, 2019