August 2017—Public Health Law News
In This Edition
Letter from the Editor
The Public Health Law Program (PHLP) would like to thank ToMinh Le and Rose Meltzer, master of public health candidates who interned with PHLP this summer, for their extensive work researching and writing the Public Health Law News. Their dedication and creativity have been outstanding. We would also like to thank intern Vasilios Nasoulis, an undergraduate with OSTLTS, for his assistance in researching stories for the July edition of the News.
PHLP welcomes public health and law students as interns and externs every semester. Every student takes on different projects, depending on their academic and professional interests; a few work on the Public Health Law News. Interested candidates should visit PHLP’s internship and externship programs webpage for more information.
F. Abigail Ferrell, JD, MPA
Editor in Chief
Hot Topics at the Intersection of Public Health and Health Care, Part I: Outbreak, Disaster, or other Emergency: Is Your Health Care Client Prepared? The American Health Law Association, in collaboration with PHLP, is offering the first in a three-part webinar series about emergency preparedness inside and outside of healthcare settings. Speakers will discuss ways to use legal assessment, employee training, and professional agreements to prepare healthcare organizations to respond to emergency situations. In addition, speakers will provide lessons learned from Ebola and active shooter incident scenarios. This free webinar will take place on September 12, 2017, 1:00–2:30 pm (EDT).
Journal Article: Federal Travel Restrictions to Prevent Disease Transmission in the United States: An Analysis of Requested Travel Restrictions. This article, published by Travel Medicine and Infectious Disease, analyzes the effectiveness of public health travel restrictions as a tool to prevent individuals with certain communicable diseases from traveling commercially.
Emergency Law Inventory (ELI).The University of Pittsburgh Graduate School of Public Health and its partners at the New York City Department of Health and Mental Hygiene, Allegheny County Health Department (Pittsburgh, Pennsylvania), and Mahoning, Trumbull, and Columbiana Counties (Ohio) released ELI, a tool that provides summaries of laws affecting participation in emergency response activities. ELI is searchable by profession and jurisdiction.
When It’s Time To Leave: Summary of California Mass Evacuation Laws. This issue brief, published by PHLP, provides an overview of how statutes and regulations in California play a vital role in ensuring that response personnel have the necessary authority to accomplish effective and efficient evacuations from threatened areas.
Vaccine Adverse Event Reporting System (VAERS) 2.0: CDC and the US Food and Drug Administration (FDA) have updated this reporting system so users can submit a VAERS report electronically, access VAERS data, and learn more about how CDC and FDA monitor vaccine safety.
State Telehealth Laws and Reimbursement Policies Report. This report, published by the Center for Connected Health Policy, the National Telehealth Policy Resource Center, offers a current summary of Medicaid provider manuals, applicable state laws, and telehealth-related regulations for all 50 states and the District of Columbia.
Florida: Florida to pay legal fees in case that kept doctors from discussing guns
New York Times (07/24/2017) Matthew Haag
Florida Governor Rick Scott has approved a payment of $1.1 million in legal fees to attorneys who sued the state over HB-155 in 2011. Known as the “docs vs. glocks” law, HB-155 restricted doctors from discussing gun safety with their patients. Under the law, doctors could lose their licenses and face up to a penalty of $10,000 per offense if they talked about gun ownership and firearm habits with their patients. A group of doctors sued the state, saying that medical providers have a right to discuss safety risks and dangers with their patients.
In February 2017, a federal appeals court ruled HB-155 unconstitutional on the basis that it tried to restrict medical providers’ First Amendment rights.
[Editor’s note: Read Florida’s HB-155.]
District of Columbia: Assisted suicide is legal and available in DC – for now
Washington Post (07/17/2017) Fenit Nirappil
Terminally ill residents of Washington, DC, can now obtain life-ending drugs under the city’s assisted suicide law. The Death with Dignity Act, passed by the DC Council in November 2016, has gone into effect. The nation’s capital joins five states—California, Montana, Oregon, Vermont, and Washington—in allowing terminally ill adults to end their lives voluntarily.
Physicians and pharmacists are not required to participate in the Death and Dignity program. Patients must be at least 18 years old and not expected to live more than six months. Patients who suffer from a psychological condition are not considered capable of making the decision and cannot partake. Patients must request prescriptions for the life-ending drugs twice, and the requests must be made at least 15 days apart. They must ingest the drugs themselves. The process is expected to take at least three weeks (i.e., between the first request and the receipt of the drugs).
Opponents of assisted suicide believe that the Act undermines life. They have also expressed concern that people with disabilities could be pressured into ending their lives early.
The DC Department of Health is responsible for regulating the implementation of the Death with Dignity Act. The department provides educational resources on the assisted suicide process and requirements for patients, physicians, and pharmacists.
National: Opioid commission tells Trump to declare state of emergency
CNN (08/01/2017) Wayne Drash
The President’s Commission on Combating Drug Addiction and the Opioid Crisis, headed by New Jersey Governor Chris Christie, formally urged Donald Trump to declare a federal public health emergency to combat the opioid crisis.
Usually, public health emergencies are declared only during natural disasters. However, the commission urged Trump to “declare a national emergency under either the Public Health Service Act or the Stafford Act” due to the health and social problems opioids have caused nationwide. More than 500,000 Americans died of drug overdoses between 2000 and 2015; opioids account for the majority of overdose deaths. “With approximately 142 Americans dying every day, America is enduring a death equal to September 11th every three weeks,” said the Commission. “The first and most urgent recommendation of this Commission is direct and completely within your control. Declare a national emergency.”
The Commission also strongly encouraged legislation to dispense Naloxone to first responders.
[Editor’s note: Read the interim report [PDF – 470KB] from the Commission on Combating Drug Addiction and the Opioid Crisis. The commission’s final report is due in October.]
California: This could be the next big strategy for suing over climate change
Washington Post (07/20/2017) Chris Mooney and Brady Dennis
[Editor’s note: Read the Register of Actions in The County of Marin v. Chevron Corp., et al, Superior Court of California, County of Marin, CIV 1702586 for more information about the case.]
Illinois: Cook County jail is giving at-risk inmates Narcan upon their release
WTTW (08/08/2017) Jay Shefsky
Massachusetts: Massachusetts enacts Pregnant Workers Fairness Act
National Law Review (07/31/2017) Robert M. Shea
[Editor’s note: Read the Pregnant Worker Fairness Act.]
Mississippi: All sworn state law enforcement will be issued Narcan to counter opioid overdoses
The Clarion-Ledger (08/03/2017) Therese Apel
Ohio: Price transparency in medicine faces stiff opposition—from hospitals and doctors
Kaiser Health News (07/31/2017) Rachel Bluth
Ohio: Insurers will make sure nearly every county has an Obamacare carrier
Cleveland.com (08/01/2017) Stephen Koff
Pennsylvania: School immunization changes go into effect this year
Pittsburgh Post-Gazette (07/31/2017) Elizabeth Behrman
Philadelphia: Transgender care latest target in health-law battles
Philly.com (07/13/2017) Eileen Bass
[Editor’s note: Learn more about lesbian, gay, bisexual, and transgender health.]
Texas: At a growing number of schools, sick kids can take a virtual trip to the doctor
STAT (07/19/2017) Leah Samuel
Texas: Judge denies ExxonMobil request to reduce $20 million air pollution fine
Texas Tribune (07/31/2017) Kiah Collier
Vermont: Vermont’s new telemedicine law expands insurance coverage, bans recording
Health Care Law Today (07/19/2017) Nathaniel M. Lacktman and Thomas B. Ferrante
[Editor’s note: Read Vermont’s telemedicine law.]
National: FDA aims to lower nicotine in cigarettes to get smokers to quit
Washington Post (07/28/2017) Laurie McGinley and William Wan
[Editor’s note: Read Protecting American Families: Comprehensive Approach to Nicotine and Tobacco, from the FDA.]
National: Legal loophole allows drug shipments into country via US Postal Service
KFVS (07/31/2017) Tom Ensey
National: In breakthrough, scientists edit a dangerous mutation from genes in human embryos
New York Times (08/02/2017) Pam Belluck
[Editor’s note: Read about genetic testing and laws related to genomics.]
Global Public Health Law
Britain: Britain cracking down on gender stereotypes in ads
New York Times (07/18/2017) Iliana Magra
India: In some countries, women get days off for period pain
New York Times (07/24/2017) Aneri Pattani
Italy: Amid measles outbreak, Italy makes childhood vaccinations mandatory
NPR (06/19/2017) Christopher Livesay
Profile in Public Health Law: Mei Wa Kwong, JD
Title: Policy Advisor and Project Director, Center for Connected Health Policy
Education: BA (international affairs), The George Washington University; JD, The George Washington University Law School
Public Health Law News (PHLN): Please describe your career path.
Kwong: I worked at a trade association in Washington, DC, after college and attended law school part-time in the evenings. After graduating from law school, I moved to California, where I grew up, and worked on state policy for a childcare and early care education organization. After a couple of years, I wanted a change, and a good friend suggested I interview with the Center for Connected Health Policy (CCHP), a new health nonprofit that was just starting up and looking for a policy person. I had no background in health policy, but I was very familiar with California’s legislative process and politics and had a pretty extensive background in bill analyses and the state budget. They saw something in me that they liked, and I’ve been working at CCHP since 2010.
PHLN: What is telehealth, and how does it differ from telemedicine?
Kwong: Telehealth is the use of electronic technology to provide health services from a distance where the patient and provider (or another provider) are not in the same location. We consider telemedicine a subset of telehealth. Telemedicine is primarily about providing medical services. Telehealth is broader: it includes education, information, care coordination, etc.
PHLN: What do you enjoy about working on telehealth issues?
Kwong: It’s always changing and evolving. Both federal and state telehealth policy are being shaped and developed right now, right before our eyes. It also stretches across many areas of policy. Telehealth policy is not just about reimbursement and payment—it’s about licensing, privacy and security, what constitutes a patient-provider relationship, etc. It’s been incredible to watch and be a part of, and I never find myself bored.
PHLN: How can telehealth improve health outcomes?
Kwong: One of the greatest strengths of telehealth is being able to provide services where the patient is located. Right now, there’s a maldistribution of specialists in this country. Large sectors of the population can’t get the services they need, not only due to financial reasons, but also simply because services might not exist where they are, particularly in rural areas. Telehealth can help by electronically bringing the service to patients when they need it.
Telehealth can also improve health outcomes by controlling chronic diseases through “remote patient monitoring,” or RPM. RPM is the continuous monitoring of a patient from a distance. It can take place in real time or not. Real-time RPM might be used in an intensive care unit—the intensivist might not be on-site with the patient but can monitor him or her electronically and can alert on-site staff if there’s an issue or if something should be examined more closely. An example of non-real-time RPM interaction is monitoring a patient with a chronic disease. For example, a patient with hypertension can be at home, taking his or her blood pressure readings daily and sending that information to his or her provider. The provider probably doesn’t look at the information as it comes in but will look at it maybe at the end of the week. CDC estimates that one in three Americans has high blood pressure. If left untreated, a person is at risk for heart disease and stroke. Catching these issues before they become more serious definitely will lead to better health outcomes and cost savings.
PHLN: One of telehealth’s biggest criticisms is that it lacks the human connection patients feel when seeing a physician in person. How would you respond to that?
Kwong: I’ve actually heard both patients and providers say telehealth has improved the connection between patients and providers. Patients say that with telehealth, they felt the provider was completely focused on them because the provider needed to look at the screen. Many in-person doctors now spend some of the visit time with their back to the patient because they’re entering information into the medical record. With telehealth, that eye contact needs to be maintained.
Telehealth can also set some patients at ease. For example, psychiatrists have told me that autistic children feel more comfortable using telehealth because they can stay in a familiar environment rather than travel to a new and different office or one that they don’t go to often. Plus, when patients are in their everyday environment, providers can see behavior that is more representative of the patients’ daily life rather than how they might react in an unfamiliar environment. So it can give the provider a more accurate picture.
PHLN: What is the Center for Connected Health Policy?
Kwong: CCHP was founded by the California Health Care Foundation (CHCF) primarily to focus on California telehealth policy, and the foundation continues to be one of our funders. In 2012, an opportunity to become the federally designated National Telehealth Policy Resource Center became available with a grant from the Health Resources and Services Administration (HRSA) and we applied for the grant and got it. We’ve been serving in that capacity since, with our work focusing both on California and the entire nation. CCHP does not lobby or provide legal advice. We’re very clear about those things when we talk to people. We provide technical assistance with our federal grant. Our other funding allows us to focus on specific projects.
PHLN: What is CCHP working on now?
Kwong: We’re just wrapping up a project with the Association of State and Territorial Health Officials (ASTHO). Through a grant from CDC, we assisted four state public health departments with very specific telehealth needs. We’re also completing a project funded by the Milbank Memorial Fund about how state telehealth private payer laws affect private payer policies.
As for our more California-based projects, we’re working on an issue brief about the use of telehealth to provide medication-assisted therapy for opioid addiction and any existing California telehealth policy barriers to it. That’s being done under our CHCF grant. We are also looking at the use of eConsult to treat patients under a grant from the Blue Shield Foundation of California.
PHLN: Can you tell us more about the project you’re working on for ASTHO?
Kwong: It was very tailored assistance based on what the states wanted. Two of the states we looked at were Oklahoma and Kentucky. They each wanted different things. Oklahoma preferred more educational-type help, so we created a series of webinars for them. Kentucky wanted to begin creating a state telehealth strategy. Although telehealth has been kind of ignored in the public health arena, I’ve been finding pockets of telehealth projects that various public health departments have going.
PHLN: Could you also elaborate on the work you’ve been doing for California’s eConsult program?
Kwong: eConsult is a web-based system that allows a primary care physician and a specialist to share health information securely and discuss patient care. Physician-to-physician electronic consultations reduce the need for unnecessary specialty referrals. For the past year and a half, CCHP has worked with stakeholders to identify regulatory and policy barriers to eConsult in California and develop a comprehensive plan to address those challenges.
PHLN: What is CCHP doing at the state and federal levels to improve access to telehealth?
Kwong: CCHP doesn’t lobby, but we provide unbiased, researched information on telehealth policy issues. In addition to the ASTHO and eConsult projects, we have created a 50-state report that describes current laws, regulations, and Medicaid policies related to telehealth. Since the report is the only one of its kind, we need to update it regularly, twice a year, which can be challenging given all the state policy action on telehealth. It’s available as a PDF and a searchable, interactive map on our website. It has been used by the telehealth community and lawmakers alike. It’s also been like a second pair of eyes for states. What I mean by that is when we update it, we might spot inadvertent errors a state has made, such as accidentally deleting something from the state’s Medicaid provider manual, or enacting a bill that literally stops mid-sentence in the text. And yes, those are both real-life examples. When we find things like that, we’ll call the relevant people in the state and ask them, “Did you really mean to do this?”
As the National Telehealth Policy Resource Center, we also get a lot of calls from federal and state lawmakers who have questions regarding bills they might wish to introduce. Again, I’m restricted from taking a position on legislation, but I do ask a lot of questions such as, “I read this as doing X and having these consequences. Did you mean for that to happen?”
PHLN: Do you think there are better opportunities for policy improvement at the state level or the federal level?
Kwong: Most legislative action on telehealth policy so far has occurred on the state level. The National Telehealth Policy Resource Center has tracked state legislation for the past five years, and we’ve definitely seen it increase over those years. Telehealth policy bills have been introduced at the federal level, but they haven’t gained much traction lately.
PHLN: How has telehealth changed since you started working in telehealth policy?
Kwong: I believe there’s been more acceptance of telehealth. It hasn’t been totally embraced by everyone, but I think more people are willing to have an open mind about it. When I first started in this arena, I would always hear, “How can it be health care—the doctor can’t touch you!” I still hear that, but not as often. Maybe it’s because technology is so embedded in our lives now or simply because more people understand what telehealth can do.
PHLN: What are the greatest challenges to successful telehealth and telehealth policy?
Kwong: Data, particularly around cost savings. Policymakers often want specific data on cost savings. A lot of existing telehealth savings data focus on cost avoidance: When you treat a condition sooner, you save money down the road. For example, when you treat someone with hypertension, he or she has likely avoided a future stroke and saved a trip to the ER and hospitalization. However, legislative scoring tends to focus on immediate outcomes, so many fiscal departments just see an expansion of services, which costs more money.
PHLN: Should telehealth be expanded in the United States? If so, why and how?
Kwong: Definitely. I don’t think it’s right that we aren’t using this tool that can provide people with services they need. People shouldn’t have to go without care simply because they can’t physically travel to see a specialist or they live in an area that doesn’t have that type of specialist, when an appointment can be made via video at their local clinic, doctor’s office, or hospital.
Telehealth policies need to catch up with technology. I understand the need to keep patient safety in mind, and even as a telehealth proponent, I don’t think telehealth is appropriate for every single situation, but there have to be some changes. For example, Medicare policy has remained essentially unchanged since 2000. Think back to what the technology was back then and compare it to what we have today. Shouldn’t things be different now, given the advances we’ve made? Minor changes were made in 2008, but even that was almost a decade ago. In 2015, Medicare provided $18 million in payments for telehealth services out of a total of $600 billion in payments for all services. Keep in mind that Medicare covers some of the people who can benefit most from telehealth.
PHLN: How do you see telehealth changing in the future?
Kwong: I see technology becoming more integrated into how we access care. I don’t think that will stop. It won’t replace human contact; some things require in-person interaction. However, I think technology will play a greater role in how we receive services, and it will be more widely accepted.
PHLN: Do you have any hobbies?
Kwong: I’ve always been an avid reader, but I read a lot for my job, so I don’t read as much as I used to in my spare time. I took up knitting a few years ago. I try to do yoga as much as possible as well. I want to master the Crow position someday!
PHLN: If you weren’t working in telehealth policy, what do you think you would be doing?
Kwong: I’m actually not certain. I sort of stumbled onto telehealth, and I’ve come to really love it. I don’t think I would have stuck with early care and education policy, but I do think I would have stayed in the policy arena, maybe environmental policy. Or maybe I would be off somewhere trying to learn how to do Crow pose.
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 2017 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!
Who are the speakers for PHLP’s upcoming webinar, Hot Topics at the Intersection of Public Health and Health Care, Part I, on September 12, 2017?
Public Health Law News Quiz Question July 2017 Winner!
Question: In which city and state will the 2017 American Public Health Association Conference take place?
Answer: Atlanta, Georgia
Employment organization and job title:
CDC, National Center for Environmental Health, Division of Emergency and Environmental Health Services, Environmental Health Services Branch, Sanitarian
A brief explanation of your job:
Presently, I provide subject matter expertise to our food safety team involving the Environmental Health Specialists Network (EHS-Net) and our National Environmental Assessment Reporting System (NEARS).
MPH from the University of Pittsburgh
Favorite section of the News:
The Top Stories
Why are you interested in public health law?
To learn how public health law can help to improve the health of the people in our communities.
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Federal: Claims for cost recovery and negligence not dismissed in lead and arsenic environmental contamination case
Rolan v. Atlantic Richfield Company
United States District Court, Northern District of Indiana
Case No. 1:16-CV-357-TLS
Opinion by Chief District Judge Theresa L. Springmann
Federal: Claims brought by Flint, Michigan, residents against officials for lead contamination not preempted by Safe Drinking Water Act, dismissal reversed
Boler v. Earley
United States Court of Appeals, Sixth Circuit
Case Nos 16-1684, 17-1144
Opinion by Judge Jane B. Stranch
Federal: Doctors’ right to ask patients about firearm ownership protected by the First Amendment right to free speech
Wollschlaeger v. Governor, State of Florida [PDF – 394KB]
United States Court of Appeals for the Eleventh Circuit
Case No 12-14009
Opinion by Judge Adalberto Jordan
Quote of the Month
Tom Dart, Sheriff at the Cook County Jail in Chicago
“We’ve got to keep them alive (and) if we can get them through that two-week window, they might get treatment, get off drugs.” —Tom Dart on the purpose of the overdose-reversing drug naloxone.
Editor’s note: This quote is from Cook County jail is giving at-risk inmates Narcan upon their release,
WTTW, 08/08/2017, by Jay Shefsky.
About Public Health Law News
The Public Health Law News is 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.
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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 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 17, 2017
- Page last updated: August 17, 2017
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