Forging Community Legal Partnerships

New Partners in Community Legal Preparedness: Public Health and the Health Care Bar

Lorraine Spencer, Susan K. Steeg, G a y Cox, Gene Matthew, and Montrece Ransom (Moderator)

Montrece Ransom The CDC’s Public Health Law Program and its part- ners have developed the Community Public Health Legal Preparedness Initiative (“Initiative”). The goal of the Initiative is to familiarize health care attorneys with the basics of public health law. This educational effort heightens awareness of the legal issues that may arise in the event of a public health emergency and better prepares the private bar to advise health care clients. The overarching theme of the Initiative is to create a partnership between the health care and pub- lic health bars so that, in the event of a crisis, the two can seamlessly interact. Because public health starts at the local level, the public and private health care communities need to band together to make sure they are legally prepared in the event of a public health emergency.

The Initiative has produced three workshops in diverse jurisdictions around the country: Atlanta, Houston, and Oklahoma. What follows is an overview of the planning and processes for these three work- shops.

Lorraine Spencer The first Community Public Health Legal Preparedness Initiative Workshop (“Workshop”) took place in Atlanta on February 21,2003. It consisted of a one-day briefing on legal preparedness topics and issues. The Atlanta Workshop can be evaluated on four levels: process, successes, challenges and out- comes.

On the process level, the most important task was to

secure an agreement with the Health Law Section of the State Bar Association of Georgia to co-sponsor the Workshop. The second prong of the process was to engage the CDC by inviting it to provide some of the speakers. The third prong of the process was the per- sonal touch: the organizer of the Workshop for Atlanta wrote personal letters, made contacts via tele- phone calls, and extended personal invitations to attend the one-day briefing to attorneys in the health care bar. As a result, the audience was comprised of attorneys representing specifically-targeted health care entities.

Additionally, there was the formation of an aca- demic partnership with the Rollins School of Public Health at Emory University since the Atlanta Workshop was held there.

The biggest success of the Atlanta Workshop was the attendance-not in terms of numbers, but because of the composition of the participants. The audience was comprised of about s i x t y people who represented public health and the private health care bar in equal measure. The Atlanta Workshop was also successful substantively, judging by the high marks on the reviews the program content received. It was also suc- cessful in its most essential objective: there are now, in Atlanta, attorneys in the leadership of the health care bar who know not only the leaders in public health, but the basic elements of public health emer- gency law as well.

There were challenges in connection with the Atlanta Workshop. The two main challenges were time and immediacy. The topic is one of great inter- est, but it competes with many others facing the tar- get audience, all of whom are stretched to meet the immediate issues before them. Thus, getting robust participation and attention to the issues was difficult

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in the absence of an actual emergency or crisis. There were several positive outcomes from the

Atlanta Workshop. For instance, the Health Law Section of the State Bar Association of Georgia has committed to publishing a desk reference that will be a compendium of the laws that apply to public health emergencies. Also, the Public Interest Law Group of the American Health Lawyers Association is produc- ing an emergency preparedness annotated checklist to respond to public health emergencies.

Susan K. Steeg The Texas Workshop was held on March 26,2004, in Houston. The program was sponsored primarily by the Health Law Section of the Houston Bar Association and the Health Law & Policy Institute of the University of Houston Law Center. It was designed to bring together public health attorneys, private health care attorneys, and community public health officials for one day of instructional and inter- active sessions.

In the early planning stages, research was conduct- ed to identify an appropriate site for the program. Important desirable factors to consider were: a large concentration of public health and health care attor- neys; academic institutions with public health inter- ests (e.g., law schools, schools of public health, and medical schools); existing health law organizations; and, if possible, a community with experience in cop- ing with a catastrophic event. Houston was chosen because it has a large and active Health Law Section of the Houston Bar Association, a city and county health department, seventy general hospitals, several medical schools and schools of public health, and three law schools. In addition, there had been a recent catastrophic flood in the area, so Houston-area hospi- tals and public health agencies had experience with hospital evacuation procedures and disaster manage- ment issues.

The topics discussed at the Houston Workshop included public health roles and responsibilities at the local, state, and federal levels. There were presenta- tions on legal issues faced in a public health emer- gency from the perspective of elected officials, public health professionals, emergency room physicians, hospital administrators, and public health attorneys.

The Workshop concluded with a case study involv- ing a SARS outbreak. Participants formed small groups for discussion of the pertinent legal issues.

Gary Cox The Oklahoma Workshop was held in Tulsa, Oklahoma, on April 1,2004, at the Adams Mark Tulsa Hotel. It was held in conjunction with a statewide public health meeting and convention.

The Workshop was sponsored by the University of Oklahoma, College of Public Health’s Institute, the Southwest Institute, which covered all the costs of the event, making it free to attend. Since no CLE credits were offered by the local bar association, however, there was low private bar attendance. Also, since the legislature was in session, no legislators attended the Oklahoma Workshop.

The Oklahoma Workshop received high evaluations and had a very good line-up of speakers. The plan for the future is to get lawyers and legislators to attend a training session in the summer of 2005 and to strengthen the Emergency Powers Act by working with state health department officials and legislators.

Gene Matthew A hundred years ago, lawyers were integral to public health at the community level. As time passed, how- ever, and as antibiotics and vaccines became preva- lent, physicians began to play a more essential role. In 1954, for example, the Salk polio vaccine led to the end of community-wide public health control meas- ures. Also in 1954, the landmark decision Brown v. Board ofEducation marked the beginning of the mod- ern evolution of procedural protections of individual liberties against government action.

The current challenges facing public health are nat- urally-occurring disasters and man-made threats to public health. As such, attorneys are once again at the forefront of public health at the community level. In the event of a public health emergency, the business community cannot afford for governments to fail. State and city lawyers’ associations and public health officers can reach out to the business community and work through the issues that arise in the event of a public health emergency. Common legal issues in public health emergencies, such as liability, compen- sation, quarantine, closure and reopening of facilities, and rationing limited supplies, can be facilitated by attorneys within the business communities.

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