January 2017—Public Health Law News

Public Health Law Program (PHLP) is thrilled to embark on another year of public health law with US state, tribal, local, and territorial communities (STLTs). In 2016 PHLP provided support to STLTs, CDC, and other federal agencies on many public health law topics, including emergency legal preparedness related to Zika, infectious diseases, behavioral health and chronic disease policies, tribal public health law, global health security, health equity, vaccines, and more.

In addition to training nearly 16,650 professionals via 29 webinars and 145 in-person trainings in FY2016, PHLP also expanded its public health law externship program, launching two new externships, one in tribal public health law and one in health communications.

PHLP was honored to present about public health law at CDC’s Public Health Grand Rounds with US Department of Health and Human Services Acting Assistant Secretary for Health, Dr. Karen B. Desalvo, in December. PHLP presented its vision to improve public health outcomes and social determinants of health through legal and policy tools and resources. As Dr. Tom Frieden said at the beginning of the session, “Law is one of the many important tools we can use to protect the public health and safety . . . Law and public health are linked because law is a key function to leverage better, faster, and longer lasting public health outcomes.”

Each of these accomplishments was made possible through leadership and support from CDC’s Office for State, Tribal, Local and Territorial Support and collaborations with STLT partners and stakeholders within and outside of CDC. We hope to build on this momentum in 2017, including launching the Public Health Law Academy—created through CDC’s cooperative agreement with ChangeLab Solutions—a collection of public health law learning modules for public health practitioners. PHLP also hopes to expand training resources for STLT public health communities and attorneys through the release of the Legal Epidemiology Competency Model, expected in fall 2017.

New announcements will be featured in the Public Health Law News. We would love to hear from you! You can reach us at PHLawProgram@cdc.gov.

Sincerely,

F. Abigail Ferrell, JD, MPA
Editor in Chief

Public Health Law Program Externships Summer 2017. CDC’s Public Health Law Program (PHLP) offers externships in public health law and tribal public health law for rising second or third year law students. PHLP also offers administrative and communication externships for students enrolled in masters-level programs in public health, public policy, public administration, communication, business, or similar disciplines. The externship consists of 9–14 weeks of professional work experience with PHLP in Atlanta, Georgia. Applications for the spring 2017 externships are due by January 31, 2017.

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Small Grants Available. The Center for Sharing Public Health Services is offering up to five small grants to organizations wishing to explore, plan, implement, or improve some aspects of cross-jurisdictional sharing (CJS) in public health. This opportunity is available for 1) public health agencies, 2) organizations representing policymakers with the authority to enter into CJS agreements, or 3) their designated agents. Applications will be considered on a rolling basis January 2‒March 31, 2017, or until all five small grants are awarded.

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Public Health Implications of Medicaid Expansion and People with Disabilities. The article “Effect of Medicaid Expansion on Workforce Participation for People with Disabilities” uses data from the health reform monitoring survey to examine differences in employment among community-living, working-age adults with disabilities who live in Medicaid expansion and nonexpansion states. (American Journal of Public Health. Published online ahead of print December 20, 2016: e1–e3. doi:10.2105/AJPH.2016.303543)

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Archived CDC Grand Rounds–Public Health Law: A Tool to Address Emerging Health Concerns. This session of CDC’s Public Health Grand Rounds, hosted December 13, 2016, celebrated PHLP’s 15th anniversary and discussed how law is an integral part of public health initiatives, such as Health in All Policies. The video, slides, and transcript of the program are available for free download.

Morbidity and Mortality Weekly Report: State Laws Requiring Hand Sanitation Stations at Animal Contact Exhibits — United States, March‒April, 2016. [PDF - 178KB] This article summarizes the results of a 50-state legal assessment that collected and analyzed state statutes and regulations requiring hand sanitation stations at animal contact exhibits. Learn more about the results of this 50-state legal assessment by reading the Menu of State Hand Sanitation Laws for Animal Contact Exhibits [PDF - 553KB].

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LawAtlas Pharmacist Vaccination Laws Map. This map explores laws that give pharmacists authority to administer vaccines and establish requirements for third-party vaccination authorization, patient-age restrictions, and specific vaccination practice requirements, such as training, reporting, record-keeping, notification, malpractice insurance, and emergency exceptions.

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LawAtlas State Emergency Suspension Powers Laws Map. This LawAtlas map covers state laws that explicitly grant governors the power to suspend, amend, or create laws during emergencies. Emergencies might involve dangers to public health, such as an outbreak of the flu; natural disasters, such as floods or earthquakes; or threats to security, such as acts of terror. 

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Constitutional Authority Statements and the Powers of Congress [PDF - 959KB]. This report provides an overview of Congress’s powers under the Constitution and Congress’s role in interpreting the nation’s founding document. The report then examines House Rule XII, clause 7(c), discussing the results of a recent study conducted by Congressional Research Service of Congressional Authority Statements (CASs) that were submitted during the last six months of the 114th Congress. The report concludes by discussing trends with regard to the House’s recent CAS practices and by providing considerations for congressional personnel drafting CASs.

National: Tightened rules for antibiotics for food livestock go into effect
STAT News  (01/03/2017)  Helen Branswell

A new rule from the Food and Drug Administration limits the use of antibiotics in food animals. The rule, known as Guidance for Industry #213, designates certain antibiotics “medically important” for the treatment of diseases in humans and can no longer be used for growth promotion in healthy food animals. Instead, animal producers can now acquire these drugs only through a prescription from a veterinarian to treat diseased animals.

This rule comes alongside growing worldwide concern about the rise of antibiotic-resistant bacteria. Health and policy experts see limiting the agricultural use of antibiotics as a key step in preserving the utility of these life-saving drugs, since 70% of antibiotics are used in food animals.

A few loopholes remain, despite the new rule. The policy does not limit access to drugs not designated medically important. It does not provide either any limits on the duration of antibiotic use, and it still allows antibiotics for illness prevention. Consequently, antibiotics can still be used for prolonged periods. Some advocates argue for more humane farming practices as another needed step in preserving antibiotic effectiveness, since many animal illnesses are caused by crowded, high-stress conditions for the animals.

“Their collective action [between the FDA and manufacturers] will help advance the global effort to slow the emergence of drug-resistant bacteria and preserve the effectiveness of these lifesaving drugs,” says Karin Hoelzer, Pew Trusts antibiotics expert.

[Editor’s note: Read the FDA’s Guidance for Industry #213 [PDF - 115KB].]

California: California Today—should unaccompanied adults be barred from playgrounds?
New York Times  (01/09/2017)  Mike McPhate

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Louisiana: Drinking water in north Louisiana town tests high for lead, copper
The Times-Picayune  (12/21/2016)  
[Editor’s note: Read about the Public Health Emergency issued for the Town of St. Joseph, Louisiana.]

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Michigan: New Michigan speed limit is fastest in Great Lakes region
Michigan Live  (01/08/2017)  Emily Lawler  

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Tennessee: Health officials share new risks associated with e-cigarettes
WKRN  (01/09/2017)  Jessica Jaglois
[Editor’s note: Learn more about the FDA’s regulation of electronic cigarettes.]

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Washington: Seattle police warn people about dangerous heroine purity
CBS Seattle  (01/09/2017)  
[Editor’s note: Read Washington’s law offering prosecutorial immunity for people who seek medical attention for someone experiencing a drug-related overdose, Revised Code of Washington 69.50.315].

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National: Delta changes policy after doctor incident on Detroit flight
Detroit Free Press  (12/21/2016)  Katrease Stafford
[Editor’s note: Read Delta’s announcement about the incident and the change of the company’s medical credential verification policy.]

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National: Let’s make a pact—states increasingly problem solve together
Governing  (12/2016)  Katherine Barrett and Richard Greene

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National: More women got mammograms when Obamacare paid for them
CNN  (01/09/2017) Susan Scutti
[Editor’s note: Learn more about preventive care benefits for women under the Patient Protection and Affordable Care Act.]

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National: New rules give nursing home residents more power
Washington Post  (12/27/2016)  Susan Jaffe
[Editor’s note: Learn more about CMS’s finalization of improvements in care, safety, and consumer protections for long-term care facility residents.]

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National: Organ transplants in the US are on the rise, but the reason why means it’s not exactly a public health triumph
Quartz  (01/10/2017)  Ananya Bhattacharya
[Editor’s note: Learn more about prescription drug overdoses, which account much of the increase in organ donations.]

France: François Hollande pardons French woman who killed abusive husband
New York Times  (12/28/2016)  Benoît Morenne

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Netherlands: Dutch fertility clinic investigates possible sperm mix-up
New York Times  (12/28/2016)  Nina Siegal

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Nepal: 15-year-old girl found dead in a menstrual hut in Nepal
NPR  (12/20/2016)  Danielle Preiss

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Russia: More than 60 Russians die from drinking bath lotion; Putin moves to cut booze tax
NPR  (12/21/2016)  Bill Chappell

Interview with Debra Gee

Title: General Counsel and Executive Officer for the Chickasaw Nation Legal Division

Education: Juris Doctorate, Arizona State University College of Law (now Sandra Day O’Connor College of Law); Bachelor of Arts, Smith College 

Tribal Affiliation: Navajo Nation (enrolled), Muscogee (Creek) Nation (affiliated)

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Public Health Law News (PHLN): Please describe your career path.

Gee: My career path has always included Indian law, whether it was working in legal services, the federal government, or tribal government. I spent my junior year of college interning with the National Congress of American Indians in Washington, DC. This experience made me realize that I should attend law school to positively affect Indian law and policy. After graduating from law school, I became a staff attorney for the DNA-People’s Legal Services in Shiprock, New Mexico. From there, I returned home to Oklahoma and worked for the Muscogee (Creek) Nation. Following a brief stint at the US Department of Justice with the Violence Against Women Office and the Office of Tribal Justice, I decided to return home again. And I have been serving the Chickasaw Nation for the past 14 years.

PHLN: What drew you to working in tribal law?

Gee: During my internship in Washington, DC, I remember the executive director at the time who gave me advice that whatever I do in life, I should do it for the Native people. I’ve tried listening to this advice in my work over the years. What’s interesting about tribal law is that you can integrate tribal customary law and contemporary law in the various issues confronting Indian tribes. This makes my job rewarding because I’m able to serve in my role and help the Chickasaw people and other Native communities.

PHLN: Will you please describe the Chickasaw Nation and how it’s different from the Navajo and Muscogee (Creek) Nations?

Gee: The Navajo, Chickasaw and Muscogee (Creek) Nations are only 3 of the 567 federally-recognized Indian tribes in the United States. Each sovereign tribal nation has its own historical, political, and governmental structures. Both the Chickasaw Nation and Muscogee (Creek) Nation have their ancestral homelands in the southeastern part of the United States. They were removed to Indian Territory (present-day Oklahoma) between 1830 and 1850 in what was known as the “Trail of Tears.” The Navajo Nation is the second largest Indian tribe and its reservation covers land in Arizona, Utah, and New Mexico. The Navajo Nation and the Chickasaw Nation have many differences, including their respective language, history, culture, and land base. However, they also face many similar challenges, including challenges to tribal sovereignty, tribal lands, tribal culture, and tribal governments.

PHLN: What are your day-to-day job responsibilities?

Gee: I’m responsible for a staff of 15, including nine attorneys within the legal division. The legal division provides in-house counsel and advice to seven overarching executive departments. My ultimate responsibility is to protect the tribal sovereignty of the Chickasaw Nation. Therefore, I perform administrative and management functions related to drafting and reviewing contracts, providing consultation and advice to tribal executive leadership, and providing oversight of cases that are prosecuted in the Chickasaw Nation District Court.

PHLN: How is your legal practice with the Chickasaw Nation different from your experiences with the Navajo and Muscogee (Creek) Nations?

Gee: I was the first tribal prosecutor for the Chickasaw Nation since the Chickasaw Nation District Court was re-established in 2004. We soon realized there were tribal laws that needed to be either created or amended. Drafting and amending laws became part of our work within the legal division. When I worked for the Muscogee (Creek) Nation, I served as the juvenile prosecutor, which was a more limited practice in tribal court. I had a much different practice in the Navajo Nation District Court because I represented individual Navajos on a variety of cases, including family law, domestic violence, public benefits, and consumer law issues.

PHLN: How is your practice different from a general counsel of a state or federal agency?

Gee: In my view, the Chickasaw Nation government is less bureaucratic than a state or federal agency. This allows our legal team to work directly with our internal clients to resolve legal issues more cohesively.

PHLN: Does one need additional or specialized legal licensing to practice tribal law? In your experience, how does licensing differ between tribes?

Gee: Being able to practice law within a tribal nation varies from tribe to tribe. For example, to practice in the Navajo Nation District Court, one has to pass the Navajo Nation Bar Exam. This exam tests specific subjects like Navajo common law, Navajo property law, and Navajo Nation jurisdiction, as well as other general topics like contracts, criminal law, and torts. Other tribal jurisdictions like the Chickasaw and Muscogee (Creek) Nations require a person to be an attorney in good standing and to be admitted to practice before a court.

PHLN: In what ways does your job as general counsel interact with public health?

Gee: The legal division works closely with the Chickasaw Nation Department of Health. In 2010, the Chickasaw Nation opened a state-of-the art health facility in Ada, Oklahoma. The department of health also operates three satellite clinics. The legal division communicates regularly with the department of health to ensure that legal issues are being addressed. As general counsel, I participate in a number of health-related projects aimed to improve healthcare delivery to the American Indians in our service area.

PHLN: What is a self-governing agreement and how does it relate to public health within the Chickasaw Nation?

Gee: The Indian Self-Determination and Education Assistance Act of 1975 authorized the US Secretary of the Interior and the Secretary of Health, Education, and Welfare to enter into agreements directly with Indian tribes. This law allowed tribes to exercise greater authority as to how they administered the funds, which gave tribes greater control over their welfare. Self-governance began in fiscal year 1988 with a handful of Indian tribes. The Chickasaw Nation began exercising self-governance in the early 1990s when it sought to redesign its programs, activities, and services with funding provided by the Bureau of Indian Affairs and the Indian Health Service. Under Chickasaw Nation Governor Bill Anoatubby’s leadership, the progress in healthcare delivery for rural south central Oklahoma has grown exponentially. The most striking example is the 370,000 square foot Chickasaw Nation Medical Center that is almost triple the size of the Carl Albert Indian Health Facility operated by the Indian Health Service and later by the Chickasaw Nation. The Chickasaw Nation Medical Center and its satellite clinics offer many health services, including pharmacy, behavioral health, diabetes clinic, family practice, and imaging, to name a few.

PHLN: How does tribal sovereignty affect the work that you do?

Gee: Protecting tribal sovereignty permeates everything we do at the legal division, from reviewing documents, agreements, and policies to providing input on a new project. We strive to ensure that the Nation’s rights as a tribal sovereign are not affected by our actions or actions by our internal departments.

PHLN: What public health issues are currently priorities for the tribe?

Gee: The Chickasaw Nation is located in rural south central Oklahoma. Like many tribes and others located in rural areas, we face issues related to access to health care, access to healthier food, drug and alcohol abuse, domestic violence, high poverty, and unemployment rates. Under Governor Anoatubby’s leadership, the Chickasaw Nation is proactively addressing these issues. Economic development initiatives, education, and career development services have greatly increased opportunities for meaningful employment. Health clinics located across the Chickasaw Nation ensure most American Indians in our service area have access to quality health care close to home. Chickasaw Nation food distribution centers provide easier access to healthy food. Counseling is readily available to those struggling with substance abuse or domestic violence. Currently under construction are a new domestic violence shelter and a Native women’s recovery center for women and their children. Additionally, a new veterans’ center is being built. All of these facilities are located on the Chickasaw Nation Medical Center campus, which further underscores the importance of integrating these services with healthcare delivery.

PHLN: Please tell us about WomenHeart. Why is heart disease an especially pressing issue for women in Indian Country?

Gee: Founded in 1999, WomenHeart is a national organization that has the mission to improve the health and quality of life of women living with or at risk of heart disease. The backbone of the WomenHeart organization is its WomenHeart champions who are volunteer educators in communities and hospitals across the country. The Chickasaw Nation recently joined WomenHeart’s National Hospital Alliance and became its first tribal health facility member. Heart disease is the leading cause of death among American Indian and Alaska Natives and they die from heart disease at younger ages than other racial and ethnic groups in the United States. American Indian and Alaska Native women are at higher risk for cardiovascular disease when compared to Caucasians. It’s important for Native women to know they can reduce the risk factors for cardiovascular disease by increasing physical activity, quitting smoking, and keeping their blood pressure, diet, weight, and cholesterol under control.

PHLN: Please tell us about your work with the Violence Against Women Act during the course of your career. What should we know about domestic violence in Indian Country?

Gee: I became involved with working on domestic violence issues when I worked at the Muscogee (Creek) Nation. In 1999, I joined the US Department of Justice’s Violence Against Women Office (now the Office on Violence Against Women) as its first tribal legal counsel. It was there that I began working on tribal domestic violence issues on a national scale on topics ranging from granting full faith and credit for protective orders and developing a coordinated community response to domestic violence. The experience working within the federal government has helped inform my work on domestic violence issues while at the Chickasaw Nation.

PHLN: You’ve worked with several tribal nations and at various levels of government. What have you learned from working within such different contexts?

Gee: I have learned that although there might be similar issues that tribal nations face, each tribe addresses these issues in a manner that is unique to that particular tribe. There is no one-size-fits-all approach for tribes. Each tribe is sovereign and, in order to work within the tribal environment, you have to ensure and respect the tribe’s sovereignty.

PHLN: What is your favorite part of your job?

Gee: There are always new questions or issues that come through the door for the legal division to address. I never get bored. I also like the fact that I’m able to affect change whether it’s drafting a new law or aiding in a new project that enhances what we do for the Chickasaw people.

PHLN: What are the greatest challenges you face in your position?

Gee: At times, it can be difficult to specialize in one aspect of Indian law when you are confronting so many issues at the same time. Fortunately, we have a large attorney staff who develop their expertise on a variety of subject areas. The new year will hold new challenges for tribes. Therefore, I think it’s important to anticipate and be ready for those challenges that will come.

PHLN: What would you be doing if you weren’t working in tribal law?

Gee: I think I would be working in some aspect of tribal government, whether as a policy maker or writer.

PHLN: Have you read any good books lately?

Gee: I was part of a book club and was intrigued by the book about Steve Jobs. I have the book “Jacksonland” that I want to read. The book is about Andrew Jackson and the Cherokee Chief John Ross.

PHLN: If you could travel anywhere in the world, where would you go and what would you do?

Gee: I’ve never traveled outside of the United States which is a big regret of mine. I would love to visit Spain.

PHLN: Do you have any hobbies?

Gee: With two preteen daughters, I don’t have much time for hobbies. I like playing the piano and running to relieve stress.

PHLN: Is there anything you would like to add?

Gee: I enjoy being an attorney and being able to address challenges and develop law and policy within the tribal environment. I’m able to help Native people, which is what I’ve always wanted to do.

The first reader to correctly answer the quiz question will be featured in a mini public health law profile in the February 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!

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Public Health Law News Quiz Question: January 2017

What country would Debra Gee like to visit?

Nathan A. Paxton

Question: What career would Beth Stephens have, if she wasn’t working in public health law and policy? 

Answer: A large animal vet.

Employment organization and job title:
United States Senate; legislative assistant

A brief explanation of your job:
Policy aide to US Senator Angus S. King (I-ME) on a variety of issues; public health is my major responsibility. I’ve recently transitioned from academia, where my research focused on the interrelation of public health and public policy, particularly with respect to HIV and communicable diseases.

Education: 
PhD in political science

Favorite section of the News:
Global Public Health Law

Why are you interested in public health law? 
Law is one of several manifestations of the decisions that governments make. I’m interested in how organizations make their decisions and why they come to particular decisions, and law is especially transparent in that regard.

What is your favorite hobby?
Rowing and my dachshunds

Connecticut: Unwarranted canine sniff of hallway outside of defendant’s apartment violated Section 7 of the Connecticut constitution, which guarantees the right to be secure from unreasonable searches and seizures.
State v. Kono
Supreme Court of Connecticut
Case No. SC 19613
Filed 12/22/2016
Opinion by Justice Richard N. Palmer

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New York: Local law to regulate use of electronic cigarettes does not violate “one- subject rule.”
NYC CLASH v. City of New York
Appellate Division of the Supreme Court of New York, First Department
Case No. 12723/14, 2104
Decided 01/03/2017
Opinion by Justice David B. Saxe

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Federal: Federal government’s classification of marijuana as a Schedule I controlled substance is for the legislative, not judicial process.
US v. Green
United States District Court, Western District of New York
Case No. 6:14-CR-06038 EAW
Filed 12/07/2016
Opinion by District Judge Elizabeth A. Wolford

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Federal: Minnesota Sex Offender Program for involuntary commitment of sex offenders does not meet the conscience-shocking standard, so overcome applied due process violation challenges.
Karsjens v. Piper
United States Court of Appeals, Eighth Circuit
Case No. 15-3485
Filed 01/03/2017
Opinion by Judge Bobby E. Shepherd

“Some of those products associated with e-cigarettes are known to have adverse health impacts. It’s just kind of the wild, wild west out there and I think that’s why the FDA stepped in and set some rules and regulations,” said Dr. David Reagan, chief medical officer for the Tennessee Department of Health.

[Editor’s note: This quote is from Health officials share new risks associated with e-cigarettes, published by WKRN, 01/09/2017, by Jessica Jaglois.]