Authorities, Organization, & Key Issues Concerning Federal, State, & Local Public Health Laws

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1 IOM Committee on Public Health Strategies to Improve Health Authorities, Organization, & Key Issues Concerning Federal, State, & Local Public Health Laws James G. Hodge, Jr., J.D., LL.M. Lincoln Professor of Health Law and Ethics Director, Public Health Law and Policy Program Sandra Day O Connor College of Law Arizona State University 1

2 Principal Objectives Snapshots of Public Health Law Jurisdictional Differences in Public Health Emergency Laws Explaining Divergent Laws and Policies 2

3 Snapshots of Public Health Law 3

4 Legal Status Concerning Expedited Partner Therapies CA WA OR NV AK ID AZ UT HI MT WY CO NM Data Current as of May 12, 2010 ND SD NE KS TX OK MN IA MO AR LA WI IL MS MI IN TN AL KY OH WV GA PR - (Puerto Rico) VI - (U.S. Virgin Islands) SC VT NH ME VA NC FL PA NY MA NJ CTRI RI MD DE DC MD Source: CDC NCHSTP, Likely Permitted 22 States Potentially Allowable 20 States Likely Prohibited 8 States

5 School Closures Laws Regarding Disease Threats CA WA OR NV AK ID AZ UT HI MT WY CO NM ND SD NE TX Data Current as of February 14, 2007 KS OK MN IA MO AR LA WI IL MS MI IN TN AL KY OH WV GA PR - (Puerto Rico) VI - (U.S. Virgin Islands) SC VT NH ME VA NC FL PA NY MA NJ CTRI RI MD DE DC MD Source: Centers for Law and the Public s Health at Johns Hopkins and Georgetown Universities, Express authorization based disease or epidemic 17 States Express authorization based on protection of the public s health 10 States General authority based on other purposes 22 States

6 Uniform Emergency Volunteer Health Practitioners Act CA WA OR NV AK ID AZ UT HI MT WY CO NM ND SD NE KS TX Data Current as of January 29, 2010 OK MN IA MO AR LA WI IL MS MI IN TN AL KY OH WV GA PR - (Puerto Rico) VI - (U.S. Virgin Islands) VA NC SC FL PA VT NH NY ME MA NJ CTRI RI MD DE DC MD Source: Enacted 4 States Introduced in States

7 State Quarantine Statutes in Emergencies CA WA OR NV AK ID AZ UT HI MT WY CO NM ND SD NE KS TX OK Data Current as of November 29, 2004 MN IA MO AR LA WI IL MS MI IN TN AL KY OH WV GA PR - (Puerto Rico) VI - (U.S. Virgin Islands) SC VT NH ME VA NC FL PA NY MA NJ CTRI RI MD DE DC MD Source: James G. Hodge, Jr., Report on State Quarantine Laws and Policies, Trust for America s Health (2004) Statutory Quarantine Power - 33 States

8 State Statutes Defining Public Health Emergency CA WA OR NV AK ID AZ UT HI MT WY CO NM ND SD NE KS TX OK MN IA MO AR LA WI IL MS MI IN TN AL KY OH WV GA VA NC SC FL PA VT NH NY ME MA NJ CTRI RI MD DE DC MD Data Current as of April 1, 2008 PR - (Puerto Rico) VI - (U.S. Virgin Islands) Source: James G. Hodge, Jr., et al, Legal and Regulatory Issues, ESAR-VHP, DHHS ASPR (Sept. 2008) Public Health Emergency or similar term in state statutes 26 states

9 Localities Defining Emergency and/or Disaster Augusta E Seattle Billings E Burlington E/D Rapid City E/D E San Francisco E/D Reno Tucson E E/D Data Current as of 2006 Denver Oklahoma City E E/D D Dallas Laredo Cook County Little Rock E/D E D New Orleans E/D E/D E E E Gwinnett County Miami New York City Philadelphia City Baltimore County E D Localities that define emergency Localities that define disaster Source: James G. Hodge, Jr. et al, ESAR-VHP Report: Focus on Local Emergency Laws, DHHS ASPR (May 2009) Localities that do not define emergency and/or disaster E/D Localities that define both

10 Principal Objectives Snapshots of Public Health Law Jurisdictional Differences in Public Health Emergency Laws Explaining Divergent Legal Policies 10

11 Levels of Emergency Declarations International Federal WHO Emergency Local Emergency Public State Emergency or Disaster Public Health Emergency Stafford Act Emergency DHHS Public Health Emergency PHEIC (Public Health Emerg. of Intern. Concern) Declarations By Intl Govs or Health Disaster Emergency 11 11

12 Levels of Emergency Declarations State emergency or disaster Local public health emergency Local emergency or disaster Federal Stafford Act emergency State public health emergency International Govts Emergency Declarations International WHO Public Health Emergency of International Concern (PHEIC) Federal DHHS public health emergency Public health authorities, powers, liabilities, immunities, and other critical legal issues vary depending on the declared emergency 12

13 WHO Confirmed Cases: H1N1 13

14 International Declarations: H1N1 April 25, 2009: WHO Director General, Dr. Margaret Chan, declares first-ever public health emergency of international concern pursuant to the International Health Regulations (2007) 14

15 International Declarations: H1N1 Source: Global Legal Triage in Response to H1N1, ASU Public Health Law and Policy Program (2009/2010) Emergency or other declarations at the national or regional levels 15

16 Domestic Declarations: H1N1 April 26, 2009: DHHS declares a national public health emergency via the Public Health Service Act, 42 U.S.C. 247d Allows federal, state, and local agencies to utilize federal resources to prevent and mitigate H1N1 Renewed at least twice by DHHS for additional 90 day periods 16

17 U.S. Cases of 2009 H1N1 Flu September 29 AK HI Legend No confirmed cases >1 confirmed cases >10 confirmed cases >50 confirmed cases As of September 29, 2009 Source: CDC, PAHO 17 17

18 Domestic Declarations: H1N1 October 24, President Declares National Emergency [G]iven that the rapid increase in illness across the Nation may overburden health care resources and that the temporary waiver of certain standard Federal requirements may be warranted in order to enable U.S. health care facilities to implement emergency operations plans, the 2009 H1N1 influenza pandemic in the United States constitutes a national emergency. U.S. President, Barack Obama White House, Office of the Press Secretary, Washington, D.C. 18

19 State Declarations: H1N1 AK HI LEGEND Federal DHHS Public Health Emergency Declaration Emergency Declaration Disaster Declaration PHE/Disaster Declaration Emergency and Public Health Emergency Declarations Last Updated: November 6, Source: Global Legal Triage in Response to H1N1, ASU Public Health Law and Policy Program (2009/2010)

20 State Declarations Timeline: H1N1 Ongoing Emergency Declaration *WHO PHEIC Declared April 25,

21 Principal Objectives Snapshots of Public Health Law Jurisdictional Differences in Public Health Emergency Laws Explaining Divergent Legal Policies 21

22 Politics 22

23 Legal Systems Separation of Powers 23

24 Legal Systems - Federalism U.S. Constitution Federal Powers State Police & Parens Patriae Powers 24

25 Legal Systems - Centralization Decentralized Public Health System Centralized Public Health System Decentralized Public Health System Centralized Public Health System 25

26 Public Health Financing 26

27 Private Sector 27

28 Public Health and Medical Science 28

29 Condition-Specific Responses Bioterrorism, Obesity,... HIV/AIDS 2000 s Cancer 1980 s Example Text Smallpox 1900 s Venereal Diseases 1920 s Polio 1940 s 1970 s 29

30 Legal Matrix ~ Public Health Agencies Level of Govt. Divergent Powers Conflicting Priorities Varying Capacities Ranging Credibility Federal National & interstate focus National guidance Deep $ and limited powers Federalism phobia State/ Tribal Intrajurisdictional Concerns Jurisdictionspecific Responses Broad authority Insufficient accreditation & licensing Local Home Rule Limitations Execution & innovation Front-line responses On the ground accountability 30

31 Challenges & Opportunities 1. Synchronizing public health laws and policies across all levels of government 2. Rebuilding public health infrastructure for the modern era 3. Grounding public health laws in legal and public health best practices 4. Dispensing with condition-specific approaches 5. Refining legal roles and responsibilities 31

32 Conclusion For additional information, please visit ASU s Public Health Law and Policy Program [ Special thanks to Ron Ordell, JD, and Chris Stringham for their research contributions to this presentation Thank you! 32

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