Public Health Law News
State Rabies Vaccine Laws for Domestic Dogs, Cats, and Ferrets in the United States Map and Legal Epidemiology DatasetExternal. CDC’s Public Health Law Program (PHLP) has published a map of state rabies vaccination laws through the Policy Surveillance Program. The interactive map features data on state-level pre-exposure vaccination laws and laws that reference the Compendium of Animal Rabies Prevention and Control.Vaccination mandates have played a vital role in decreasing rates of rabies, which is fatal but preventable in humans and animals.
Public Health Emergency Law Online Training. CDC’s Public Health Emergency Law (PHEL) course prepares state, tribal, local, and territorial practitioners to make informed legal decisions related to emergency preparedness and response activities. PHEL consists of three competency-based units and covers legal issues to consider before, during, and after public health emergencies. Each interactive unit takes about 40 minutes to complete.
- Unit 1—Introduction to Emergency Management Systems Preparedness and ResponseExternal
Covers the legal underpinnings of emergency management systems
- Unit 2—Emergency Powers: Protection of Persons, Volunteers, and RespondersExternal
Describes legal considerations for personnel responding to emergencies
- Unit 3—Emergency Powers: Management and Protection of Property and SuppliesExternal
Examines considerations surrounding materials and property during public health emergencies
Job Opening: Special Advisor to the Chief Medical OfficerExternal. The March of Dimes is seeking applications for a new position with the organization: special advisor to the chief medical and health officer (CMHO). The special advisor will work directly with the CMHO on key policy, systems, and strategic issues to improve the health of moms and babies. The position will be based in Arlington, Virginia. The March of Dimes leads the fight for the health of all moms and babies and believes that every baby deserves the best possible start. The position will remain open until filled.
Pay to Play? State Laws Related to High School Sports Participation FeesExternal. 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 RelationshipsCdc-pdf[PDF – 1.22MB]External. 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.
How Legal and Policy Levels Can Amplify Efforts to Reach Healthy People GoalsExternal. The HHS Office of Disease Prevention and Health Promotion is hosting a webinar on Thursday, April 25, at 1‒2 pm (EDT) as part of the Healthy People Law and Health Policy Project. The webinar will focus on how policy and laws can be used as tools to improve public health and reach Healthy People goals. It will also include insight from a leading public health scholar and provide practical community examples.
An Assessment of State Laws Providing Gubernatorial Authority to Remove Legal Barriers to Emergency Response.External 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. The article outlines the findings of the 50-state assessment and gives examples of how governors have used this legal authority during emergencies.
Legal Epidemiology in Practice: Exploring the Impact of Food Desert Laws and Policies in Louisville, KYExternal. Temple University’s Center for Public Health is hosting a webinar on Tuesday, April 23, at 1‒2 pm (EDT) in collaboration with PHLP and ChangeLab Solutions. The webinar will focus on the Louisville Metro Health Department’s year-long legal epidemiology project with PHLP on local policy incentives to increase access to healthy food.
Opioid Epidemic Toolkit for Local Health DepartmentsExternal. This toolkit from the National Association of County and City Health Officials provides resources for preventing local opioid overdoses. It includes resources for monitoring and surveillance, prevention, harm reduction and response, linkage to care, and stakeholder engagement and community partnerships.
A Blueprint for Changemakers: Achieving Health Equity through Law & Policy—Partner ToolkitExternal. ChangeLab Solutions has published a toolkit to aid policy makers who are working on health equity. The toolkit includes legal and policy strategies that can be used to transform systemic obstacles to health inequities and can be used at the local level to transform health outcomes for all communities.
A Snapshot of State Proposals to Implement Medicaid Work Requirements NationwideExternal. The National Academy for State Health Policy has put together waiver statuses of states that are attempting to implement work requirements for Medicaid recipients. The chart includes states’ pending and approved waivers, renewals, and amendments for both work and community engagement requirements.
Injury Prevention in American Indian and Alaska Native Communities. CDC’s National Center for Injury Prevention and Control has launched a page dedicated to injury prevention work in native communities. The webpage includes data, publications, research, and tools that address this topic.
Washington, DC: Overcoming stigma: the treatment and prevention of HIV in Indian CountryExternal
Indian Country Today. (03/26/2019) Pauly Denetclaw
As part of his initiative to end HIV in the United States, the President has allocated $25 million in his 2020 budget to Indian Health Services (IHS) for HIV and hepatitis C screening and treatment. New cases of HIV occur more often in populations of American Indians and Alaska Natives (AI/ANs). CDC reported that of the estimated 3,600 AI/ANs who were living with HIV in 2016, 82% had received a diagnosis. In 2015, approximately 60% of AI/AN people who were living with HIV had received treatment, 43% had maintained treatment, and 48% had achieved viral suppression.
The stigma surrounding HIV is one of the biggest obstacles to fighting the disease. Among the screening initiatives, IHS wants to expand the use of pre-exposure prophylaxis (PrEP) for “high risk” individuals. Over the past year, IHS has encouraged those individuals to use PrEP and has continually tried to reduce stigma around the disease. The new initiative’s goal is to partner with Native communities that are most affected to spread awareness and cut down on stigma.
The United States already spends around $20 billion a year for HIV health expenditures, spending that has been effective in driving down the rate of HIV infection. The new funding will go to communities hardest hit by the disease.
HIV infections are highest among men who have sex with men and minority populations, including AI/ANs. The new HIV initiative will aid people in these demographic groups and areas by investing in prevention programs at community health centers, surveillance where HIV is spreading fastest, and by creating local HIV clinics to expand prevention and treatment.
“We know that in partnership with Native communities, we can end the HIV epidemic in Indian Country by strategically focusing our efforts on communities most impacted,” said Rear Admiral Michael Toedt, Chief Medical Officer for IHS.
National: Amid teen vaping boom, states raise age for e-cigarette and tobacco sales to 21External
Route Fifty (04/02/2019) Bill Lucia
Governors Andrew Cuomo (New York) and Jay Inslee (Washington) are set to sign bills raising the legal age for tobacco purchases to 21. Since 2016, nine other states have raised the age to buy tobacco. Utah, Arkansas, Hawaii, California, New Jersey, Oregon, Maine and Massachusetts have all raised the legal age to 21, with Illinois not far behind in signing the bill into law. These moves come after an increase in tobacco use, particularly e-cigarettes and vaping, among teenagers.
Thomas Carr, the national policy director for the American Lung Association, says of the tobacco 21 movement, “I think it really has taken off this year. I think it will become a nationwide standard of some kind.”
Tobacco 21 legislation at the national level, however, has been unsuccessful. In 2018, lawmakers introduced a bill raising the age to 21 nationwide but the bill failed. Tobacco is still a leading cause of preventable death in the United States, and 95% of adult smokers began using tobacco before age 21. To reverse these trends, anti-smoking and other organizations continue to advocate for federal law prohibiting tobacco sales to people under age 21.
Washington’s secretary of health says raising the minimum age of tobacco sales to 21 is one of the most important policies a state can have to protect the health of minors.
Arkansas: Judge strikes down Medicaid work rules in Arkansas, KentuckyExternal
Politico (03/27/2019) Rachana Pradhan
[Editor’s notes: Read the full opinionExternal.]
California: L.A. County expands smoking ban to vaping tobacco and smoking pot in publicExternal
Los Angeles Times (03/26/2019) Matt Stiles
Louisiana: Gilead and Louisiana agree to a ‘Netflix’ subscription model for hepatitis C drugsExternal
STAT (03/26/2019) Ed Silverman
New York: New York suburb declares measles emergency, barring unvaccinated children from publicExternal
The New York Times (03/26/2019) Michael Gold and Tyler Pager
[Editor’s note: Read the Rockland County declarationCdc-pdf[PDF – 714KB]External of a local state of emergency.]
New York: Amid New York measles outbreaks, 1 county orders exclusions from public spacesExternal
NPR (04/17/2019) Francesca Paris
[Editor’s note: Learn more about the Rockland County Department of Health Communicable Disease and Exposure Exclusion OrderExternal.]
New York: New York declares measles emergency, requiring vaccinations in parts of BrooklynExternal
The New York Times (04/09/2019) Tyler Pager and Jeffrey C. Mays
[Editor’s notes: Read the NYC Department of Health’s Order of the CommissionerExternal and the vaccination requirementExternal in Brooklyn and Queens. Also, learn more about De Blasio’s declarationExternal and why mandatory vaccinationsExternal are necessary.]
New York: NY lawmakers propose giving teens right to vaccinate without parental consentExternal
TimesUnion (03/08/2019) Bethany Bump
[Editor’s note: Read the proposed billExternal.]
South Dakota: ‘A State of Emergency’: Native Americans stranded for days by floodingExternal
The New York Times (03/24/2019) Mitch Smith
National: Anti-vaxxers have been raising money with GoFundMe. The site just put a stop to it.External
The Washington Post (03/22/2019) Lindsey Bever
National: Survey: About 1 in10 US adults rationing medicine in effort to lower costsExternal
The Hill (03/19/2019) Peter Sullivan
National: F.D.A. approves first drug for postpartum depressionExternal
The New York Times (03/19/2019)
[Editor’s note: Read the press releaseExternal.]
National: Why the promise of electronic health records has gone unfulfilledExternal
NPR (03/18/2019) All Things Considered
National: Housing department slaps Facebook with discrimination chargeExternal
NPR (03/28/2019) Brakkton Booker
[Editor’s note: Read the Charge of DiscriminationCdc-pdf[PDF – 47KB]External.]
National: Why pedestrian deaths are at a 30-year highExternal
NPR (03/28/2019) Sea Stachura
Brunei: Brunei’s new anti-LGBTQ law endorses stoning and whippingExternal
Vice (03/27/2019) Mustika Hapsoro and Edoardo Liotta
Canada: Canada to create national drug agency to help cut cost of medicinesExternal
Reuters (03/19/2019) David Ljunggren
European Union: Europe bans single-use plastics. And glitter could be next.External
The Washington Post (03/28/2019) Emily Tamkin
[Editor’s note: Read more information on the banExternal.]
Mozambique: Cyclone-hit Mozambique: cases of cholera, malaria, typhoidExternal
Al-Jazeera (03/23/2019) Enoch Muchinjo
[Editor’s note: Learn more about Mozambique’s cholera vaccination campaignExternal.]
Pakistan: WHO condemns the killing of polio worker in PakistanExternal
[Editor’s note: Read the full press releaseExternal.]
South Africa: Faeces in the kitchen: South Africans call for better sewage systemsExternal
Thomson Reuters Foundation News (03/21/2019) Kim Harrisberg
Global: 3 years on, what’s become of the EU-Turkey migration deal?External
Associated Press (03/20/2019) Elena Becatoros
[Editor’s note: Learn more about the agreementExternal.]
Global: Dramatic housing transformation in sub-Saharan Africa revealed for first timeExternal
London School of Hygiene & Tropical Medicine (03/27/2019)
Title: Member attorney, Motley Rice LLC
Education: JD, University of South Carolina School of Law; BA, Wofford College
Public Health Law News (PHLN): Will you please describe your career path?
Ledlie: After doing some work with environmental advocacy groups and nonprofits, I decided that going to law school would provide a path for me to advocate directly for change. While environmental law is still an interest for me, my professional work has mainly focused on public health issues arising from the use of consumer and industrial products.
PHLN: Why were you interested in environmental law?
Ledlie: I’ve always found both inspiration and fulfillment in being in a truly natural environment. Natural places deserve and demand our protection. There are more challenges being placed on our natural environment than ever before, and it is important for everyone to move forward with some vision of a sustainable future.
PHLN: Will you please describe your current practice areas?
Ledlie: I’ve had a quite varied practice representing people harmed by toxic exposures. This has included representing individual smokers and their families against cigarette manufacturers as well as people suffering from mesothelioma as a result of asbestos exposure. I recently served as co-lead counsel of a national multidistrict litigation (MDL) for US soldiers and contractors harmed as a result of exposure to burn-pit emissions in Iraq and Afghanistan. Another new toxic exposure civil case I’ve been working on involves methylene chloride-based paint strippers that caused accidental deaths. This work has involved advocacy to change Environmental Protection Agency (EPA) regulations, including implementing a ban on consumer sales of methylene chloride paint strippers.
Currently, I’m involved in a number of lawsuits relating to the opioid epidemic in the United States. My firm represents dozens of local and state governments in claims against opioid manufacturers, distributors, and retail pharmacies for their role as the alleged root cause of the opioid crisis. Among the allegations are that the crisis is a result of deceptive marketing practices for opioid medications and oversupply of prescription opioids that went well beyond any medical need.
While challenging and complex, this litigation is crucial in helping our cities, counties, states, and others come together to heal those who are suffering and to abate the opioid epidemic. Civil litigation is one instrument that can help shed light on how we got here and help provide the resources governments and communities need to move forward in addressing the epidemic.
PHLN: As you’ve said, you are currently representing several Ohio jurisdictions in the ongoing consolidated opioid litigation in federal court. Without commenting too much on ongoing litigation, could you please describe the current consolidated cases?
Ledlie: According to CDC, an estimated 130 Americans die every day from an opioid overdose. Our case is premised on the fact that the manufacturers, distributors, and retail pharmacies of opioid medications participated in destigmatizing and overly broadening the use of prescription opioids and thereby oversupplying them. We allege that these companies did so in a manner that was unacceptable in light of the known, highly addictive risks of opioids causing not just individual cases of addiction and overdose, but also a societal epidemic that strikes at the very core of communities and their aggregate public health well-being. We recognize that opioids are necessary for many patients, including cancer patients, and for end-of-life care. The litigation focuses on finding innovative solutions and the best path forward for a highly complex problem.
PHLN: The current opioid litigation has been compared with tobacco litigation. You and your firm also have significant experience in tobacco litigation. Again, without commenting too directly on ongoing litigation, could you please describe how the opioid cases are different from traditional tobacco litigation?
Ledlie: Cigarettes and prescription opioids are both highly addictive products, but they are different. In my opinion, cigarettes are always an inherently defective product. Opiate medications, on the other hand, can be both medically necessary and appropriate for patients under the appropriate circumstances, such as reducing symptoms in people with terminal illnesses. The opioid litigation is far more complex in that there are more moving parts—cities, counties, and states each have unique damages. The defendants are also more diverse, as the litigation covers everyone in the supply chain, from the prescription manufacturer through the retail dispenser.
PHLN: Do you consider yourself a public health lawyer? Why or why not?
Ledlie: I’ve always been interested in using the court system to advocate for cases that seek to protect the health and safety of both individuals and communities. I think my interest in medicine and science has certainly led me into areas of law that touch on areas of both individual and community health.
PHLN: You also mentioned working on methylene chloride regulation. What is methylene chloride, and why it could be a health threat?
Ledlie: Methylene chloride is a colorless chemical. It has historically been used in commercial and industrial paint strippers, metal cleaning, and other commercial applications. Methylene chloride fumes can be very toxic if inhaled and can kill in seconds. My work has involved “do it yourself” (DIY) paint strippers found at your local hardware store. Numerous consumers have died from inhaling fumes from these DIY products.
PHLN: How did you get involved methylene chloride regulation?
Ledlie: A young man in my community, Drew Wynne, died from using a methylene chloride paint stripper product, despite wearing gloves and a mask. After doing more research, I was shocked at how dangerous and readily available this product was. In addition to bringing a civil case against Lowes (where he purchased the product) and WM Barr (the manufacturer of Goof Off®, the product he was using), the family wanted to advocate to make sure no other family had to go through what they’d experienced. Many national retailers and hardware stores have recently taken steps to get these products off the shelves following advocacy efforts by my clients, the Wynne family, and consumer protection organizations. The product is simply not safe for consumers to use.
PHLN: What is the current status of methylene regulation in the United States?
Ledlie: Following the advocacy efforts of the Wynne family and others, the EPA instituted a ban of most applications of methylene chloride, which should largely confine its use to certain regulated commercial settings. It is a step in the right direction and comes after years of advocacy efforts.
PHLN: What, specifically, did you and your clients do to support the promulgation of regulations to protect individuals from methylene chloride?
Ledlie: So long as methylene chloride remained on store shelves, our clients, the Wynne family, knew there was a chance that someone else could die and that families nationwide would be at risk of suffering the same tragedy they’d experienced. They chose to honor Drew’s memory by advocating, with our support, for the removal of methylene chloride from Lowe’s, the store where Drew purchased the product that ultimately cost him his life. Their advocacy efforts were instrumental in convincing national retailers to phase out paint strippers containing methylene chloride and are a testament to their devotion to the cause. We are hoping the recent EPA ban will be the final step in keeping consumers safe from these hazards. It is bittersweet, though, because the ban is not as protective as it should have been, as it will leave commercial workers at risk of dangerous exposure to methylene chloride.
PHLN: When does the regulation go into effect, and what does it say?
Ledlie: The final rule was issued on March 15, 2019. According to the EPA, the agency “issued a final rule to prohibit the manufacture (including import), processing, and distribution of methylene chloride in all paint removers for consumer use. EPA has taken this action because of the acute fatalities that have resulted from exposure to the chemical. Paint removal products containing methylene chloride will not be able to be sold at any retail or distribution establishments that have consumer sales, including e-commerce sales. Those prohibitions start 180 days after the effective date of the final rule, which provides time for establishments selling this chemical to consumers to come into compliance with EPA’s ban. EPA is also requiring manufacturers, processors, and distributors to notify retailers and others in their supply chains of the prohibitions and to keep records. Additionally, EPA is soliciting public input for a future rulemaking that could establish a training, certification and limited access program for methylene chloride for commercial uses. EPA is asking for input on the key elements required for such a program.”
PHLN: Over your tenure as a public health attorney and throughout your experiences litigating public health issues, what have been some of the most important lessons you’ve learned?
Ledlie: Hard work ain’t easy, but it’s fair. You need to be willing to stay focused on the task at hand for months, years, or even longer to make a lasting impact.
PHLN: What would you say to other people who want to improve environmental and public health in their communities?
Ledlie: Start in your local community, and start today. There are so many ways to bring about positive changes right where you are.
PHLN: Do you have any hobbies?
Ledlie: Because my job involves so much travel, I try to find time to soak in all the interesting spots off the beaten path and absorb local culture. I love food and wine and always try to figure out what is unique to where I am. I also love being home in my native low country of South Carolina: throwing a casting net, walking the beach, getting out in the boat. I recharge by getting outdoors and spending time with family and friends.
[Editor’s note: Learn more about the EPA’s ban of consumer sales of methylene chloride paint removersExternal.]
The first reader to correctly answer the quiz question will be featured in a mini public health law profile in the May 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 April 2019
PHLP published a LawAtlas map and legal epidemiology dataset on what topic related to dogs, cats, and ferrets?
Which state featured in the March 2019 News has never allowed nonmedical vaccine exemptions and also has not had a measles outbreak in 25 years?
Winning Answer: West Virginia
Employment organization and job title: Defense Healthcare Agency/Ft. Belvoir Community Hospital, Clinical Nurse Specialist
A brief explanation of your job: I serve as the Community Health Promotions program manager lead. My main role is performing community assessment and then analyzing the results to design, develop, promote, implement, and evaluate population-based wellness programs for active duty military/retirees, their family members, and federal workers at Fort Belvoir, Virginia. I also manage the Seasonal Influenza Vaccination Program for the hospital and satellite clinics, including the Pentagon.
Education: BA, law enforcement; BS, nursing; MS, nursing with a focus in public health nursing administration
Favorite section of Public Health Law News:Global Public Health Law, because it reminds me of both similarities and differences in culture and perspective throughout the world.
Why are you interested in public health law? Emerging manmade and natural disaster/threats to public health have moved from local to global. In order to respond appropriately, public health workers need many cross-disciplinary skills. Understanding public health law and its application in a particular community setting, whether at the county, state, tribal, or country level, is vital for improving both response and long-term recovery.
What is your favorite hobby? Boating, kayaking, fishing—anything on the water!
Arkansas: The court considered the constitutionality of the local-option framework allowing citizens of White County to vote to prohibit the manufacture and sale of alcoholic beverages after Mr. Brennan challenged the framework. Mr. Brennan argued that the local option was unconstitutional on its face and more specifically violated his substantive due process rights to contract and association. He also explained how citizens may travel to neighboring counties for alcohol endangering county highways. Further, Mr. Brennan argued that drug-related crimes become a greater threat in dry counties. White County responded that prohibiting the manufacture and sale of alcohol promotes the public health and reduces crime among other advantages.
The parties argued whether rational basis was the appropriate test to determine the constitutionality of the statute. This court held that rational basis applied because regulating an industry of general public interest falls within the broad state police powers. Additional reasons for holding the rational basis test application was because the Supreme Court of Arkansas had previously held that selling alcohol is a privilege rather than a right, that imposing a majority morality is not the only purpose of the local-option framework, and that the effectiveness of the framework is irrelevant for determining the constitutionality of a statute. Thus, the court affirmed White County Circuit Court’s order dismissing Mr. Brennan’s request for declaratory judgment.
Brennan v. White County, ArkansasExternal
Arkansas Court of Appeals, Division I
Case No: CV-18-638
Opinion by Judge Bart F. Virden
Kentucky: The Court of Appeals of Kentucky held that the question of medical need for marijuana is a decision for the legislature. Seum argued that the state statutes criminalizing the possession and sale of marijuana for medical purposes were unconstitutional as arbitrary and a violation of their right to privacy. The lower court held that the issue was nonjusticiable because it is a political question and settled in a prior state Supreme Court case. In that case, the Supreme Court of Kentucky held that controlling marijuana was a valid public interest related to health, safety, and criminal activity. The discretion of what threatens the public health and welfare is left to the state legislature.
Seum, et al. v. BevinExternal
Kentucky Court of Appeals
Case No. 2017-CA-001695
Opinion by Chief Judge Denise Clayton
Federal: The Occupational Safety and Health Administration (OSHA) cited the Walmart Distribution Center #7035 for violating bloodborne pathogen regulations. Walmart failed to comply with the regulation that stipulates hepatitis B vaccinations be provided to employees who serve on a Serious Injury Response Team (SIRT). The standards by OSHA and CDC require that SIRT employees receive all three rounds of the hepatitis B vaccine. The court ruled that Walmart did not provide the third vaccine and knowingly failed to provide four SIRT members with the vaccine. Walmart also did not offer the vaccine within 10 working days of the assignment for the SIRT team. The court denied Walmart’s petition to drop the citations against it.
Wal-Mart Stores East, LP v. AcostaExternal
United States Court of Appeals for the Eight Circuit
Case No. 17-2647
Opinion by Judge L. Steven Grasz
“The lack of resources, the lack of water, lack of transportation and the lack of facilities—this really compounds all of the issues,” said Valentina Merdanian, a tribal council member, of the flooding on the Pine Ridge Indian Reservation in South Dakota.
[Editor’s note: This quote is from ‘A State of Emergency’: Native Americans stranded for days by flooding.External
The New York Times (03/24/2019) Mitch Smith]
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.
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,or persons quoted therein, 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 Web sites 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 Newsis in the public domain and may be freely forwarded and reproduced without permission. The original news sources and the Public Health Law Newsshould be cited as sources. Readers should contact the cited news sources for the full text of the articles.