Network for Public Health Law - Western Region
The Network for Public Health Law builds relationships, delivers technical assistance, and provides training to lawyers, public health practitioners, and policy-makers on how to use law to improve the public's health. Technical assistance includes legal guidance memoranda, training guides, legal outlines, and other tools designed to help practitioners understand and apply law to the protection and promotion of public health.
The Network is organized into 5 regions dedicated to providing public health law technical assistance and support on a wide range of topics to federal, state, tribal, local partners and colleagues in private sectors.
The center houses the Network for Public Health Law – Western Region Office, which provides extensive guidance and technical assistance across multiple western states and nationally on Emergency Legal Preparedness and Response, Vaccination Law and Policy, and other topics.
The Western Region is led by James G. Hodge, Jr., J.D., LL.M., Director, Leila Barraza, J.D.,M.P.H., Associate Professor, University of Arizona Zuckerman College of Public Health, Senior Consultant, Jennifer L Piatt, J.D., Deputy Director and Erica N. White, J.D., Senior Attorney.
Model Public Health Laws
Uniform Emergency Volunteer Health Practitioners Act - Developed by the Uniform Law Commission (ULC) and completed in 2007, UEVHPA provides uniform legislative language to facilitate organized response efforts of volunteer health practitioners responding to public health emergencies.
Turning Point Model State Public Health Act - Beginning in 2000, the Robert Wood Johnson Foundation funded a multi-disciplinary group as part of its Turning Point Initiative from five states (Alaska, Colorado, Nebraska, Oregon, Wisconsin), multiple national organizations, and governmental agencies to conceive and draft a comprehensive model state public health act. The Turning Point Act offers model public health legislative provisions based on best practices for state, local, and tribal governments seeking to revise or update their public health laws.
Model State Emergency Health Powers Act - MSEHPA grants public health powers to state and local public health authorities to ensure strong, effective, and timely planning, prevention, and response mechanisms to public health emergencies (including bioterrorism) while also respecting individual rights. Developed by the Centers for Law and the Public's Health: A Collaborative at Johns Hopkins and Georgetown Universities with multiple partners in 2001, state and local legislators and health officials nationwide use the MSEHPA as a guide for considering public health law reform in their states.
Model State Public Health Privacy Act - Developed in 1999 with support from CDC and with significant input from an expert advisory group, MSPHPA addresses privacy and security issues arising from the acquisition, use, disclosure, and storage of identifiable health information by public health agencies at the state and local levels. The Act regulates the handling of identifiable, health-related information by public health agencies without significantly limiting the ability of these agencies to use such information for legitimate public health purposes.
Projects
The Preemption Project is a key component of the Law Partnership, an initiative funded by the Robert Wood Johnson Foundation to build a culture of health through collaborative efforts with the Network for Public Health Law, ChangeLab Solutions, Public Health Law Center, CDC Public Health Law Program, and Temple University’s Center for Public Health Law Research. Through the initiative, partners are test piloting the Five Essential Public Health Law Services Framework to strengthen public health legal infrastructure in support of the development and implementation of laws and policies.
Preemption is a legal tool used by the federal and state governments to override the authority of lower-level governments to act on certain issues. State and local governments are drivers of innovative approaches in public health policy making. While preemption can be a positive tool for state or national uniformity on key laws or policies, it can also limit grassroots movements and evidence-based public health laws and policies.
Past examples of tobacco control efforts highlight both the efficacy of state and local efforts in improving the public’s health, and the detrimental effect of preemption. Some localities have implemented indoor smoking bans or local cigarette taxes effective in curbing tobacco usage and exposure. Preemptive laws at the state level can prohibit, restrict, or obfuscate local authority on such measures.
ASU’s PHLP and ChangeLab Solutions are partnering on the Preemption Project to identify strategies to address preemptive tactics. We are reaching out to state and local governments, public health advocates and professionals, and public health lawyers to provide insight, information, and resources. Deliverables include case studies, typology briefs, legal scoping memoranda, and a preemption template tool. A final report will recommend actions to address the gaps in identifying preemptive tactics and formulating effective response strategies.
The Association of the State and Territorial Health Officials (ASTHO) with support from the Office of the Assistant Secretary for Preparedness and Response (ASPR), seeks to create innovative and realistic opportunities to include emergency medical services (EMS) providers into regular, everyday activities within a wide variety of communities throughout the nation.
This project engages innovative and relevant legal and policy research that will ultimately determine legal obstacles that may hinder the activities of health professionals in routine community paramedicine (CP). CP is a new model of community-based healthcare that is designed to use already existing EMS systems and personnel to enhance access to primary care and reduce overuse of EMS and costs.
As part of this endeavor, Professor James G. Hodge, Jr. and PHLP colleagues reviewed and analyzed the current legal landscape surrounding EMS personnel and investigated laws that expedited or impeded the expanded EMS roles. The report analyzes legal issues underlying the use of expanded EMS activities including authorizing deployment of EMS personnel, liability concerns, scope of practice, standard of care, venue restrictions, medical supervision requirements, and reimbursement.
The resulting report, Expanding the Roles of Emergency Medical Services Providers: A Legal Analysis (2014), reveals new and alternative strategies and resources to expand the roles of EMS systems and personnel to assist medically underserved populations for each identified obstacle.
Law provides critical support for public health efforts and responses during declared emergencies. Building public health legal capacity at the local level is crucial for emergency preparedness planning and response. After action reports from the 2009/2010 H1N1 response indicate that local health departments face numerous legal hurdles in responding to health incidents including protection from legal liability, coordination and procurement of resources and response efforts among public and private actors, expansion of public health legal authority, and standards for credentialing volunteers.
Because local emergency preparedness and response efforts may be needed prior to an emergency declaration, educating local public health entities to provide a strong foundation for the nation’s public health in emergencies is essential.
In conjunction with NACCHO, Professor James G. Hodge, Jr. and PHLP colleagues are producing a curriculum to help prepare public health practitioners, their legal counsel, and other partners to understand and effectively address key issues in legal preparedness. The end product is a locally-customizable training curriculum and exercise scenarios, instructor’s manual, training component summaries, and training videos.
From 2005-2007, the Centers for Disease Control and Prevention (CDC) collaborated with the Centers for Law and the Public’s Health at Georgetown and John Hopkins Universities to complete the first phase of a public health initiative to aid state and local governments to implement Expedited Partner Therapy (EPT). EPT is the clinical practice of treating the sex partners of patients diagnosed with an STD, such as gonorrhea or chlamydia, without clinical assessment of the partners in order to quickly curtail further transmission.
In 2010, CDC, working with PHLP, began a second phase of this project. Principal investigator James G. Hodge, Jr. and his PHLP colleagues were tasked with providing assistance to states who are interested in adopting statutes or regulations that permit EPT as well as those who have already adopted these regulations but needed help implementing them. The final deliverable is a Toolkit providing a resource for voluntary use by state and local government officials. It includes sample state legislative language, a discussion of selected issues related to practitioners’ liability, as well as general guidance concerning drafting and implementing legislation and regulations concerning EPT.
The Health Impact Project, a collaboration of The Pew Charitable Trusts and The Robert Wood Johnson Foundation, is a national initiative designed to promote the use of health impact assessments (HIAs) as decision-making tools for policymakers.
HIAs are commonly used in health sectors to assist researchers and policy makers in making decisions that will minimize population-based harms and maximize public health benefits. The Health Impact Project seeks to expand the use of HIAs in multiple sectors, including through environmental policy. The National Environmental Policy Act (NEPA) and State Environmental Policy Acts (SEPAs) require governmental agencies to fully assess potential adverse environmental impacts of a proposed action or policy.
Though not explicitly required by NEPA, HIAs have strong legal and policy support for use in facilitating the environmental review process because they provide agencies with a data-driven approach to quantifying adverse impacts on human health and safety with the potential to improve public health.
In a two-stage project, Principal Investigator James G Hodge, Jr. and PHLP colleagues along with colleagues at Association of the State and Territorial Health Officials (ASTHO) examine the legal and practical underpinnings of utilizing HIAs in environmental reviews. PHLP’s main effort entails a legal overview of NEPA and its tribal, state, and local equivalents in 17 jurisdictions, identifying 10 themes to embed HIAs and other health considerations into the environmental review process at various stages. Statutory and regulatory frameworks, executive orders, case law, and past environmental review examples each illustrate distinct opportunities to infuse health considerations and HIAs into the NEPA or SEPA process. These highlighted paths provide opportunities for public health practitioners and officials, advocates, community interest groups, and others to ensure the health impacts of projects assessed under NEPA and SEPAs are considered, evaluated, and mitigated where possible.
Sponsored by the Centers for Disease and Control and Prevention (CDC) in collaboration with the Johns Hopkins Bloomberg School of Public Health, a project team led by James G. Hodge Jr., explored the legal and ethical environments related to mental and behavioral health before, during, and after declared emergencies that impact the public's health.
Among the many topics addressed under the guidance of multiple investigators and a Project Advisory Group include: mental and behavioral health services in the public and private sectors, liability, antidiscrimination, disability protections, health information privacy, governmental benefits, professional licensure of mental health personnel, human subjects research, and health and disability insurance.
Several applied tools intended to aid mental health providers, emergency workers, and public health practitioners to address mental health needs before, during, and after emergencies are listed below:
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Frequently Asked Questions about Legal Preparedness for Health Care Providers and Administrators, Public Health Officials, Emergency Planners, and Others Regarding Mental and Behavioral Health
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The Health Impact Project, a collaboration of The Pew Charitable Trusts and The Robert Wood Johnson Foundation, is a national initiative designed to promote the use of health impact assessments (HIAs) as decision-making tools for policymakers. HIAs use a flexible, data-driven approach that identifies the health consequences of new policies and develops practical strategies to enhance their health benefits and minimize adverse effects. Through the use of public health research and risk analysis, HIAs can help researchers and policy-makers reduce population-based harms and maximize the benefits of a given project.
HIAs have been used extensively in health sectors domestically and abroad. The effectiveness of these evaluations has encouraged researchers to determine whether HIAs might be a viable tool in non-health sectors such as environment and energy, transportation, agriculture, and waste disposal recycling to enhance the public’s health and well-being.
Principal Investigator James G Hodge Jr. and PHLP colleagues address how existing laws may facilitate the use of HIAs in non-health sectors through extensive legal and policy research focused on a specific sample of federal, tribal, state, and local laws. Thirty-six jurisdictions were selected for legal research based on their geographic, political, ethnic, and population-based diversity, as well as the electronic availability of their laws. The final report is entitled Legal Review Concerning the Use of Health Impact Assessments in Non-health Sectors.
Please see below various information, including international and domestic legal declarations of emergency, memoranda, articles, checklists, and other documents that can accessed online or in PDF format (subject to continued availability of active links) on emerging legal issues in response to the global spread of H1N1 in 2009-2010.
International or Regional Declarations of Emergency or Public Health Emergency
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Afghanistan Declaration of Public Health Emergency ~ November 2, 2009
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Nicaragua State of National Health Emergency ~ August 27, 2009 [and renewed on September 25, 2009]
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Gujarat (India) Invocation of Epidemic Disease Act ~ August 19, 2009
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Malaysia Declaration of Health Emergency ~ August 17, 2009
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Manitoba First Nations Declaration of Emergency ~ June 24, 2009
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Yemen State of Emergency ~ June 17, 2009
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Ecuador Declaration of Emergency ~ April 29, 2009
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Costa Rica Declaration of Health Emergency ~ April 28, 2009
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Colombia Declaration of Emergency ~ April 27, 2009
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WHO Declaration of Public Health Emergency of International Concern (PHEIC) ~ April 25, 2009
U.S. Federal Declarations of Emergency, Public Health Emergency, and Waivers
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FDA Emergency Use Authorization for Medicines and Diagnostic Tests for Swine Flu in Humans ~ April 27, 2009
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DHHS Declaration of a Public Health Emergency ~ April 26, 2009 (reissued on July 23, 2009)
U.S. State and Territorial Declarations of Emergency or Public Health Emergency
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U.S. State-Based Emergency Declarations Map (PDF) ~ updated November 6, 2009
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State of Maryland Declaration of Emergency ~ Emergency Medical Services Staffing (PDF) ~ November 6, 2009
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State of New York Declaration of State Disaster Emergency ~ October 28, 2009
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State of Illinois Proclamation of Public Health Emergency (PDF) ~ October 14, 2009
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State of Ohio Proclamation of Emergency (PDF) ~ October 9, 2009
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State of Maryland Declaration of State of Emergency and Catastrophic Health Emergency (PDF) ~ May 1, 2009
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State of Florida Declaration of Public Health Emergency (DOC) ~ May 1, 2009
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American Samoa Declaration of Public Health Emergency ~ May 1, 2009
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State of Nebraska Declaration of Emergency ~ April 30, 2009
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State of Wisconsin Declaration of Public Health Emergency ~ April 30, 2009
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State of Maine Declaration of Civil Emergency (PDF) ~ April 29, 2009 [and renewed on September 30, 2009]
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State of Texas Disaster Declaration ~ April 29, 2009 through May 29, 2009
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State of Ohio Declaration of Emergency (PDF) ~ April 28, 2009 through June 12, 2009
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State of California Declaration of Emergency ~ April 28, 2009
Legal Preparedness and Response to H1N1 - General Links
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CDC H1N1 Influenza Pandemic Emergency Authorities Matrix (PDF) ~ current as of October 27, 2009
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Emergency Influenza Containment Act, H.R. 3991 (introduced in Congress)
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CMS H1N1 Fact Sheets - Section 1135 Waivers
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The Model State Emergency Health Powers Act
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The Swine Flu Outbreak and International Law
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The Legal Landscape for School Closures in Response to Pandemic Flu or Other Public Health Threats
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Principles and Practice of Legal Triage During Public Health Emergencies (PDF)
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Emergency System for the Advance Registration of Volunteer Health Professionals (ESAR-VHP) Legal and Regulatory Issues Project
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The HIPAA Privacy Rule and Bioterrorism Prevention, Planning, and Response
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Will Swine Flu Merit Quarantines? If So, New Law Gives States Authority ~ Deborah Cassens Weiss, ABA Journal Online, April 27, 2009 (quoting James G. Hodge, Jr.)
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CDC Public Health Law Program Swine Flu Legal Preparedness
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European Public Health Law Network H1N1 (Swine Flu)
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Legal Preparedness and Response to H1N1 - Workers' Compensation
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Is H1N1 Compensable Under Workers Compensation?
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Swine Flu: Is Your Workplace Prepared (PDF)
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Swine Flu Claims Possible for Comp, Life Insurance
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World Health Organization
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Weekly Epidemiology Record of H1N1
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Confirmed Cases of New Influenza A H1N1 Global Map
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H1N1 surveillance data for African countries
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H1N1 surveillance data for eastern Mediterranean countries
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H1N1 surveillance data for European countries
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H1N1 surveillance data for South-East Asia
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National Influenza Pandemic Plans
Additional Links
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GAO Highlights: Influenza Pandemic: Monitoring and Assessing the Status of the National Pandemic Implementation Plan Needs Improvement
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UMNCPHP Training Module: Introduction to Business Continuity Planning for Disasters and Emergencies
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UMNCPHP Training Module: Preparing Employees for a Disaster in the Workplace
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BOMA Planning Guide for Commercial Buildings: Influenza Pandemic
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BOMA Planning Toolkit for Commercial Buildings: Influenza Pandemic
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CDC Frequently Asked Questions About Federal Public Health Emergency Law
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U.S. State Dept H1N1 Travel Alerts
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U.S. Defense Dept Weekly surveillance summaries across the military health system
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PAHO H1N1 Data for Pan American Countries
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UN Office for the Coordination of Humanitarian Affairs - National pandemic preparedness plans of Asia-Pacific countries
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UN News Centre. News Focus: Influenza
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European Centre for Disease Prevention and Control Weekly Influenza Surveillance Overview
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American Public Health Association H1N1 (Swine Flu) News
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National Association of County and City Health Officials H1N1 (Swine Flu) Updates
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National Association of Local Boards of Health H1N1 (Swine Flu) Updates
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National Conference of State Legislatures H1N1 (Swine Flu) Update
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International Air Transport Association Travel Advisories Issued by Governments
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Johns Hopkins Office of Critical Event Preparedness and Response (CEPAR) H1N1 (Swine Flu)
In 2013, the Center for Disease Control and Prevention’s (CDC) Healthcare Preparedness Activity (HPA) in collaboration with the Department of Transportation’s National Highway Traffic Safety Administration (NHTSA) and Oak Ridge Associated Universities (ORAU)/Oak Ridge Institute for Science and Education (ORISE) created a forum to discuss expanded EMS roles during a medical surge event.
Following this meeting, ORAU and CDC instituted a two-part project including key legal inserts to the EMS Framework Report, as well as a legal analysis of potential issues that may impact EMS providers in the event of a medical surge during emergencies.
PHLP colleagues analyzed the statutes, regulations, and case law of 20 key states to guide relevant laws and policies regulating EMS providers during PHEs and surge events. Their report examines the steps that various jurisdictions and entities can take for pre-surge planning and preparedness, and the shifting levels of authority based on an emergency declaration.
After identifying potential legal challenges concerning adequate EMS personnel to address response needs, liability risks and protections for EMS providers in a public health emergency are assessed. Other legal and practical issues are explored as well, including access to additional health care supplies, allocation of critical resources, and reimbursement. For more information, see the final report, Emergency Medical Services & Medical Surge: Essential Legal Issues (2015).
The Ethics in Public Health Emergency Preparedness Project is a collaboration of the Lincoln Center for Applied Ethics and PHLP. The primary objective is to create a model code of public health emergency ethics for health care, public health, and emergency preparedness officials and practitioners in Arizona.
This effort commenced with a one-day meeting and workshop on November 4, 2011 of individuals of varied backgrounds including: bioethicists, public health ethicists, emergency planners, hospital administrators, public health officials, and legal counsel. This select group convened to consider multifarious ethical issues at the intersection of public health and emergency preparedness.
The goal of the project is to generate a series of core principles of ethics to help guide critical decisions among public and private actors during public health emergencies. Development of an Arizona-based model Code of Public Health Emergency Ethics may help provide consistent, morally-justifiable guidance for these difficult decisions. This model was subsequently used to frame similar principles as part of Arizona's Crisis Standard of Care Committee.
In collaboration with the Association of the State and Territorial Health officials (ASTHD), the National Association of County & City Health Officials (NACCHO), and the Center for Disease Control and Prevention (CDC), this report assesses legal and policy issues regarding use of nurse triage lines (NTLs) during a pandemic. Materials from a stakeholders meeting in March, 2012 in Atlanta regarding the larger project are available from NACCHO.
NTLs are telephone hotlines staffed by Registered Nurses who can provide essential information, make initial assessments, and issue prescriptions for antiviral medications using established decision support tools. NTLs can improve access to antiviral medications and reduce strain on health care and public health systems during an emergency. A national network of state- or region-based NTLs built on existing telephonic infrastructures may potentially enhance response during a future pandemic event.
The report discusses legal challenges related to: NTL design, professional relationships between NTL staff and callers, standard of care, operationalization before and during declared emergencies, ensuring adequate personnel and appropriate authority, and liability protections. Potential solutions to these challenges are proffered based on interpretations of law and practice and lessons learned from prior emergencies.
