Laws and Policies for

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Opal Allison
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1 Lessons from H1N1: Laws and Policies for Preparedness and Resilience A Local Health Department s Perspective Richard L Vogt M D Richard L. Vogt, M.D. Tri-County Health Department, Colorado September 14, 2010

2 Tri-County Health Department (TCHD) TCHD is the largest local health department (LHD) in Colorado, serving 1.3 million residents Located in the Denver metropolitan area suburbs that are north, east and west of the City and County of Denver Eleven offices throughout our jurisdiction We have a staff of around 375 FTEs and an annual budget of $36 million

3 H1N1 TCHD Effort H1N1 first appeared in the U.S. in April, 2009 Investigated individual cases May-August Planned for a vaccination campaign from May September Provided 351,000 doses of H1N1 vaccine to health care providers (HCPs) Administered 63,157 vaccinations in 62 different Point of Dispensing sites (PODs)

4 Background Governor s Expert Emergency Epidemic Response Committee (GEEERC) Created in Colorado statutes in 2000 Thirty members from local health departments, hospitals, non-profit and state agencies Drafted emergency rules for the governor to sign if a disaster is declared and state statutes need to be temporarily suspended Power to isolate and quarantine State seizure of medications to distribute to select individuals Creation of temporary hospital beds

5 Challenges Encountered by LHDs LHD sources of direction Federal laws, regulations and policies State laws, regulations and policies Local policies GEEERC Format for presentation Problem Proposed remedy

6 Federal and State Laws, Regulations and Policies Problem: Colorado state health department (SHD) distributed the strategic national stockpile (SNS) with Tamiflu and personal protective equipment (PPE) without LHD consultation Use was restricted and there was concern about accountability, so few items were accepted 20 palettes of Tamiflu and PPE in storage Remedy: Close work between Centers for Disease Control and Prevention (CDC), SHDs and LHDs to best utilize the SNS

7 Federal and State Laws, Regulations and Policies Problem: Inconsistent direction by CDC and SHD on collection of patient data CDC allowed collection of limited data on H1N1 vaccinees but Colorado SHD wanted more Colorado SHD developed forms that were to be scanned for inclusion cuso in our immunization ato registry egsty Most forms were unusable; project was abandoned Remedy: Have the CDC, SHDs and LHDs develop a uniform set of variables and pilot a scannable form for future events

8 State Laws, Regulations and Policies Problem: Colorado has adopted statutes and regulations that allow only nurses, doctors and some emergency medical technicians (EMTs) to administer shots TCHD s attorney unsuccessfully worked to expand the professional groups who could vaccinate TCHD had to hire outside nurses to administer shots Remedy: Reconsider using dentists, medical assistants and other EMTs supervised by licensed nurses to give shots during pandemics

9 State Laws, Regulations and Policies Problem: the SHD delegated the process for allocation of H1N1 vaccine to LHDs Advantages We had more control over inventory TCHD could retain specific formulations for our clinics Disadvantages Each LHD allocated vaccine differently Some vaccinated high-risk individuals, others vaccinated all Remedy: Have a more flexible allocation system between LHDs LHDs agree to standardize target vaccine groups

10 Local Policies Problem: one local hospital demanded that none of their personnel obtain H1N1 FluMist This affected much more than their hospital personnel because the rule applied to others in the hospital including outside EMTs, and outside physicians Remedy: Have the CDC provide clearer guidance for clinical partners. Also, have the Chief Medical Officer of the SHD provide acceptable protocols for vaccine or drug delivery to health care facilities.

11 Summary LHDs had several challenges with federal, state and local statutes, regulations and policies that impacted our ability to conduct this campaign In general, federal and state agencies should have developed LHD advisory committees that could have better provided a local perspective Additional executive orders which suspend state statutes during pandemics should be developed We can and should learn from this experience

Public Health Emergencies: Volunteer Recruitment

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