Public Health Law News

August 2019

Editor's Note

The Public Health Law Program (PHLP) would like to recognize and thank Florence “Liz” Schroeder for her assistance researching and writing the June and July editions of Public Health Law News. Ms. Schroeder is expected to graduate in 2020 from Columbia University Mailman School of Public Health with a master of public Health.

PHLP would also like to recognize Nicholas Calvin for his assistance researching and briefing the judicial opinions for the June, July, and August editions of the News.Mr. Calvin is expected to graduate in 2020 with his juris doctorate from Samford University’s Cumberland School of Law and his master of public health from the University of Alabama at Birmingham School of Public Health.

We hold these interns in deepest regard and wish them every success in their future endeavors.

F. Abigail Ferrell, JD, MPA
Editor-in-Chief

Announcements

How Are Telehealth Laws Intersecting with Laws Addressing the Opioid Overdose Epidemic?external icon The Journal of Public Health Management & Practicepublished a new article discussing the different ways in which telehealth laws are potentially helping to fight the opioid crisis. A legal mapping study was completed to demonstrate how telehealth laws are helping to increase access and availability of identified strategies by CDC to address the opioid epidemic. Learn more about telehealth laws and public health.


Webinar: Testing a New Terminology System for Health and Social Services Integration.external icon The Systems for Action Individual Research Project, a program of the Robert Wood Johnson Foundation, will host a webinar on August 21, 2019, at 12:00 pm (EDT). The webinar will explore a study that is testing a change of the current coding system language to include for social services. The intent is that by modifying the current system to allow for reimbursement of social and healthcare services under one billing system, social services will be more affordable and accessible in order to properly address the social determinants of health.


Job Openings: Fulbright Visiting Research Chair from the United States.external icon Applications are now open for the University of Ottawa Centre for Health Law, Policy and Ethics’ Fulbright Visiting Research Chair from the United States for 2020–21. The application deadline is September 16, 2019.


Calling for Submissions: Greener Guidance Health Advice Column.external icon Greener Guidance is an anonymous environmental health advice column that is currently seeking questions or challenges in environmental health from local health departments. Responses are published monthly by the National Association of County and City Health Officials.


Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity.external icon A new article released by The National Academies details the steps needed to align science, practice, and policy to progress health equity for children who are at risk for negative outcomes.

Legal Tools

Public Health Emergency Law Online Training. CDC has developed a free online training course that trains public health practitioners on how to make informed legal decisions regarding emergency preparedness and response when an emergency happens. Each session takes about 40 minutes to complete.


Return-on-Investment (ROI) Calculator to Help Healthcare Organizations Meet All of Their Patients’ Needs.external icon The Commonwealth Fund created this tool so that healthcare organizations can assess the benefits and risks of investing in health-related social needs for patients with high-cost, complex conditions. The ROI calculator was developed with the reasoning that it takes more than just healthcare solutions to treat diseases. This tool gives organizations the ability to determine whether the cost of providing nonmedical needs for patients will be lower in the long run than the healthcare costs of treating these patients.


Tools for Change: A Resource Catalog for Community Health.external icon ChangeLab Solutions provides this compilation of tools and resources about a variety of topic areas. Everything is free and includes, but is not limited to, model policies, how-to guides, infographics, and fact sheets.

Top Stories

Utah: Utah Family Sues After Son with Diabetes Is Kept from Schoolexternal icon
The New York Times   (06/29/2019)   Christine Hauser

Story Highlights

Approximately 167,000 Americans under age 20 have Type 1 diabetes. Although it can develop at any age, Type 1 diabetes is generally diagnosed in young people. Consequently, school districts and families must work together to manage this illness while diagnosed children attend school.

State and federal laws require public schools to accommodate the medical needs of students and prohibit discrimination on the basis of disability. Several states equip school personnel with the skills to give routine insulin and emergency glucagon. Additionally, students can have an individual plan of action written by a doctor or nurse.

Under Utah state law, students can inject themselves with medication if they have approval from a doctor and the child’s parents, or a trained school staff member can administer the medication in accordance with the student’s health plan. The Watkins Family of Salt Lake County have, however, clashed with school officials on plans for managing their 8-year-old son’s diabetes. KW, as the lawsuit refers to him, was forced to complete his studies at home by his school district.

School district policy allows medication to be administered via syringe only if prefilled by the drug manufacturer or a pharmacist. KW needs a specific type of diluted insulin, which his mother says is “impractical, unaffordable, and not covered by insurance” if filled by a pharmacist. KW nearly suffered a life-threatening medical emergency because a school nurse had improperly filled his insulin.

The school district and parents have tried to create a plan that both parties are happy with—where K.W. is allowed to return to school—yet a compromise has not yet been reached. The Watkins family is suing the school district for allegedly violating KW’s rights. Despite the disagreement and the child’s frustration about not attending school with his friends, the school has provided KW with an at-home learning plan and has proposed sending a teacher to his house for a few hours per week.

[Editor’s note: Learn more about Utah’s State Laws, Regulations, and Policies for School Diabetes Careexternal icon.]

Briefly Noted

California: California is 1st state to offer health benefits to adult undocumented immigrantsexternal icon
NPR   (07/10/2019)   Bobby Allyn
[Editor’s note: Read more about the billexternal icon.]


Florida: Florida health officials declare public health emergency for hepatitis Aexternal icon
USA Today   (08/03/2019)   Sara Marino
[Editor’s note: Learn more about hepatitis A and Florida’s public health emergency declarationexternal icon.]


Pennsylvania: Philadelphia declares state of emergency after surge of hepatitis Aexternal icon
CNN   (08/02/2019)   Susan Scutti
[Editor’s note: Read Pennsylvania’s public health emergency declarationexternal icon.]


New Hampshire: Federal judge strikes New Hampshire’s Medicaid work requirementsexternal icon
The Hill   (07/29/2019)   Nathaniel Weixel


Oregon: Oregon allows doctors to waive aid-in-dying wait periodexternal icon
Pew Charitable Trust   (07/24/2019)   Michael Ollove


National: Breast implant recalled after link to more rare cancer casesexternal icon
Associated Press   (07/24/2019)   Matthew Perrone


National: Despite federal protections, rape victims still get billed for forensic examsexternal icon
Kaiser Health News   (07/12/2019)   Michelle Andrews


National: New law will require breastfeeding rooms in federal buildingsexternal icon
FedSmith   (07/29/2019)   Ian Smith
[Editor’s note: Read the Fairness for Breastfeeding Mothers Act of 2019external icon.]


National: Trump administration plans to allow imports of some prescription drugs from Canadaexternal icon
ABC News   (07/31/2019)   Bill Chappell


National: US records 25 new measles cases as outbreak spreads to Ohio, Alaskaexternal icon
Reuters   (07/22/2019)   Gabriella Borter


National: 14 teens, young adults in 2 states hospitalized for lung disease that may be linked to vapingexternal icon
WFLA/CNN   (08/04/2019)
[Editor’s note: Learn more about public health and electronic cigarettes and vaping.]


National: 22 states considered eliminating the ‘Tampon Tax’ this year. Here’s what happened.external icon
The New York Times   (07/12/2019)   Karen Zraick

Profile in Public Health Law: Max Gakh, JD, MPH
Photo: Max Gakh, JD, MPH

Title: Assistant Professor, University of Nevada, Las Vegas School of Public Health; Associate Director, University of Nevada, Las Vegas Health Law Program

Education: JD, The Ohio State Moritz College of Law; MPH, Johns Hopkins University Bloomberg School of Public Health; AB, Washington University in St. Louis


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

Gakh:After working as a staff attorney for a state government agency, where I drafted legislation, analyzed legal issues, and staffed legislative committees, my interest in health led me to work in public health legal preparedness at a university center. I pursued an MPH for formal training in public health and then completed a Robert Wood Johnson Foundation Visiting Attorney Fellowship with the Partnership for Public Health Law, a collaboration of several public health organizations based at the American Public Health Association in Washington, DC. I am currently faculty at University of Nevada, Las Vegas (UNLV), where I research and teach in this area of public health law and policy and work closely with community partners. I’ve been very fortunate to have the support of excellent teachers, mentors, and colleagues along the way.

PHLN:What drew you to public health law and equity and, more specifically, the Health in All Policies (HiAP) approach?

Gakh:Public health law resonates with me because it provides a framework for how law can directly help communities and because it relies on multiple disciplines and perspectives to solve problems. Seeing how social factors shape health in my own communities and through academia and practice catalyzed my interest in health equity. I became curious about HiAP because it provides one way to address these social factors, which I think can seem daunting.

PHLN:What is HiAP, and what is it supposed to achieve?

Gakh:HiAP is usually described as an approach or an idea; at its core, it is supposed to bring a health perspective into decisions that have health consequences but traditionally do not consider them. For example, decisions about K‒12 education can affect health through students’ access to healthy food and physical activity, and they can also impact the highest level of education students receive, which is an important health determinant. HiAP is rooted in established concepts, including the idea that government sectors should collaborate to solve problems.

PHLN:What are the differences between formal and informal HiAP?

Gakh:HiAP is a big idea, and there are different ways to do HiAP. You can bring health concerns into other sectors by investing in cross-sector partnerships or data utilization or workforce training. An informal HiAP strategy might involve a health department building strong ties with a transportation department with the hope that conversations and relationships would encourage transportation decisions that consider health. A formal HiAP approach includes the use of law or policy. For instance, a statute or executive order could set up a cross-sector task force to solve a specific problem with health components. These two approaches often work in concert. For instance, implementing a law-based requirement that sectors collaborate around a health-related problem involves maintaining effective partnerships.

PHLN:Can you provide some examples of HiAP implementation?

Gakh:There are some great examples. To an extent, I think how you define HiAP dictates the pool. Relying on a broad definition of integrating health across decisions, well-known examples of HiAP implementation with a formal component include California’sexternal icon and Vermont’sexternal icon HiAP task forces (established by gubernatorial executive order), Rhode Island’s Commission for Health Advocacy & Equityexternal icon (created by statute), Appleton, Wisconsin’s HiAP-focused local ordinance, and Tacoma, Washington’s board of health resolution. Each example pursues HiAP differently. (See editor’s note at the end of this interview for legal mechanisms creating HiAP).

PHLN:How could formal HiAP work to help achieve health equity, especially within minority or under-resourced communities?

Gakh:Although formal HiAP strategies might not dictate particular decisional outcomes, institutionalizing a health and health equity perspective across sectors could encourage health-promoting actions. For example, a Montana executive order institutes an Office of American Indian Health in the state health department and requires it to consult with tribal health and tribal government leaders as it works to promote health equity (Mont. Exec. Order No. 06-2015 [June 16, 2015]).

PHLN:What sets HiAP apart from other approaches or frameworks? What might be the benefits of incorporating HiAP into existing systems?

Gakh:Achieving HiAP aims has potential to improve multiple health outcomes at the same time and to increase equity. I also think what makes HiAP unique is one of its major challenges: integrating health across decisions involves a sea change. Jurisdictions that have pursued HiAP attempt to translate the concept into something that is both concrete and contextual.

PHLN:How is HiAP related to health impact assessments?

Gakh:Health impact assessments (HIAs) are systematic tools to inform decisions affecting the social determinants of health through a pre-established six-step process. They bring data, evidence, and stakeholder feedback to recommend ways to promote health. Many who work in this area think that HIAs and HiAP are connected; HIAs can be part of a HiAP effort, HiAP can be implemented without HIAs, and HIAs alone do not achieve HiAP. For example, Massachusetts’s “Healthy Transportation Compact,” which was established to integrate health into state transportation decisions, encourages the use of HIAs (M.G.L.A. 6C Sec. 33).

PHLN:How can you determine if a HiAP is effective?

Gakh:That’s a great question. It’s difficult for a few reasons, and it depends on what “effective” means. It can be hard to attribute an improvement in a specific health outcome to HiAP. It’s challenging to know what outcomes to measure, and as many have suggested, seeing the fruits of the social determinants of health work can take considerable time. Also, it can be difficult to compare HiAP across jurisdictions because of varying contexts and implementation strategies. However, there is interesting work out there. Some of it focuses on how HiAP efforts impact values and priorities, capacity to consider health, and institutionalization of health as a key consideration.

PHLN:What are the challenges to implementing HiAP? What are some ways to overcome these obstacles?

Gakh:One challenge is how to turn HiAP into something concrete. Others include limited resources and knowledge, pre-existing structures and processes, evaluation challenges, and prioritizing HiAP. Overcoming these challenges necessitates a long-term commitment to HiAP and its principles.

PHLN:What advice would you give others who are beginning to think about HiAP?

Gakh:It’s an exciting time to think about HiAP, partly because there is so much to learn. Think about HiAP in both the long and short term. There are some great case studies that illustrate different HiAP approaches. And assessing context to determine what is most appropriate for your jurisdiction is a great place to start.

PHLN:Where can jurisdictions interested in implementing HiAP, whether it be formal or informal learn more?

Gakh:There are some excellent resources out there. They include:

PHLN:Have you read any good books lately?

Gakh:Yes! Can’t We Talk about Something More Pleasant?: A Memoir by Roz Chast; The Refugees by Viet Thanh Nguyen; and There There by Tommy Orange come to mind.

PHLN:Do you have any hobbies?

Gakh:I enjoy clearing my head with a run or hike, reading and listening to books, and music.


Editor’s Note:

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 September 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 August 2019

What federal law requires that federal buildings that are open to the public and have public restrooms also have designated lactation rooms that would be open to both the public and federal employees?

July 2019 Quiz Winner
Photo: Gwyneth Eliasson

Gwyneth Eliasson

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

Winning Answer: California

Employment organization and job title: School of Public Health—SUNY Downstate Health Sciences University; Assistant Professor, Department of Health Policy & Management

A brief explanation of your job: I teach Public Health Law & Ethics and co-teach other courses; provide job search/career advisement and writing support services to students; and contribute @DownstateSPH tweets.

Education:  JD, Brooklyn Law School; MPH in Health Systems & Policy, Rutgers School of Public Health; BA in English, Binghamton University

Favorite section of Public Health Law News: It’s a toss-up between “Legal Tools” and “Court Decisions,” both of which inspire course content.

Why are you interested in public health law? For me, public health and social justice are intertwined. Before getting my MPH, I was a Legal Services NYC and public interest attorney advocating for low-income clients facing benefits insecurity and other systemic, structural health challenges. I have worked at, researched, and consulted for medical-legal partnerships, innovative programs that embed lawyers in healthcare settings. Now, I’m teaching at a school of public health focused on urban and immigrant health.

What is your favorite hobby? Reading! I’m currently reading “Well: What We Need to Talk About When We Talk About Health” by Sandro Galea. Next, I plan to read “Priced Out: The Economic and Ethical Costs of American Health Care” by the late Uwe Reinhardt.

Court Opinions

New York: In 2015, James Cromwell trespassed on private property to prevent construction vehicles from entering the site for a new power plant. Cromwell chained himself to two other people and blocked construction vehicles from entering the area, causing traffic to back up. These actions led to Cromwell being arrested and charged for disorderly conduct. He claimed a defense of ‘justification by necessity,’ defending himself against the criminal charges because his criminal actions were necessary to stop an immediate harm. Cromwell argued that his actions were necessary and justified, not only to help prevent environmental damage by the power plant, but also to prevent public injury that wound ensue because of the plant worsening global warming. The court agreed that global warming was a problem, but that Cromwell’s actions did not meet the qualifications for a ‘justification by necessity’ defense. His actions were deemed to not meet the standard of preventing imminent harm because the identified threat he sought to prevent—global warming—was speculative or remote, as the power plant was not to be completed for two years. Because Cromwell did not prove that his actions were necessary, his criminal charges conviction for disorderly conduct was confirmed.

People v. Cromwellexternal icon
Supreme Court, Appellate Term, Second Department, New York State
Case No.2017-1310-ORCR
Decided 06/13/2019


Federal: In the town of North Tonawanda, New York, multiple owners of residential property filed a class action lawsuit against the town of Wheatfield alleging that they were exposed to toxic and hazardous substances without their knowledge, and that the town withheld information about the dangers from the residents. These toxic substances were housed in a local landfill in Wheatfield, just north of the residential properties, and was operated between 1964 and 1968. In 1968, waste from the infamous Love Canal Landfill, along with material from a local chemical company, were dumped in the landfill. The residents had no knowledge of the landfill’s presence as it had limited signage, was not fenced in, and appeared to be a forest. The residents used the land as a recreational area after 1968, and alleged that such use led to toxic substances being transmitted to the local residents. The district court ruled against each of the plaintiff’s arguments, finding that their allegations remained vague and conclusory, as they identified a list of contaminants and their possible health effects without alleging a plausible connection between the contaminant and a condition suffered by a plaintiff. The court also found that without knowing which substance was alleged to be the causation agent, there was no means of determining whether a claim had been stated against a particular defendant. The defendant’s motion to dismiss was granted.

Andres v. Town of Wheatfieldexternal icon
United States District Court for the Western District of New York
Case No. 1:17-cv-00377
Decided 06/14/2019
Opinion by District Judge Christina Reiss

Quote of the Month

“This is one of those things that already was a topic of priority for the Department of Health in terms of controlling this virus, and seeing how the number of cases was continuing to rise, we thought a public health emergency was the next step to help get the message out to the public about how this virus is being spread,” said Florida Surgeon General of the state’s declaration of a public health emergency to address Florida’s current hepatitis A outbreak.

[Editor’s note: This quote is from Florida health officials declare public health emergency for hepatitis Aexternal icon, USA Today, 08/03/2019, by Sara Marino.]

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: August 15, 2019