The U.S. Department of Health and Human Services has released "Tabletop exercises for pandemic influenza preparedness in local public health agencies." The report presents a fully customizable template for a tabletop exercise for pandemic influenza preparedness that can be used by state and local health agencies and their healthcare and governmental partners.
The Performance Institute will host "The 2007 National Summit on Homeland Security for Public Health and Hospitals," on January 18-19, 2007, in Arlington, Virginia. The summit will feature strategies to improve medical preparedness and ensure effective victim response. For more information, visit http://www.performanceweb.org/CENTERS/LE/Events/H117/H117.htm?source=cdc&campaign;=H117 or contact Brian Dutton at Dutton@performanceweb.org. Use the discount code H117-CDC to receive $200 off the cost of registration.
Yesterday, the New York City Board of Health approved the country's first major municipal restriction on the use of artificial trans fats in restaurant cooking. Trans fat, chemically modified fat used as a substitute for saturated fat, has been linked to heart disease. The Board of Health, composed mainly of physicians and health professionals appointed by the mayor, decided to phase in the rule in response to implementation concerns expressed by the restaurant industry. On July 1, 2007 restaurants will no longer be allowed to prepare recipes that contain over a half-gram of trans fat per serving, and by July 1, 2008 they will have to remove all prepared menu items that surpass the new limit. The city's health inspectors will assess fines of at least $200 for violators. Experts said the new regulation would be a model for other cities such as Chicago, which is currently considering a similar rule. But some chefs and restaurant owners oppose the restriction, saying there is no substitute for the taste and texture that trans fat provides. Dan Flesher, a spokesman for the National Restaurant Association, expressed his group's opposition to the measure and said it could be challenged on legal grounds. "This is a misguided attempt at social engineering by a group of physicians who don't understand the restaurant industry," he said. But New York City Mayor Michael Bloomberg explained, "We are just trying to make food safer."
[Editor's note: The New York City Department of Health and Mental Hygiene press release describing the trans fat restriction includes links to the regulation's final notice of adoption and to a summary of public comments received regarding the proposed rule. It is available at http://www.nyc.gov/html/doh/html/pr2006/pr114-06.shtml.]
Last week, a 30 year-old Massachusetts man filed a lawsuit against The Scotts Co. alleging that the lawn and garden company violated his privacy when it fired him for smoking cigarettes. Scott Rodrigues claims he was fired from his lawn-care job after a drug test determined he had nicotine in his system. According to Rodrigues, he was not told he would be tested, and he was also told the company would help him quit smoking. Rodrigues also said he had never smoked at work or while on break. According to his complaint, "this case challenges the right of an employer to control employees' personal lives and activities by prohibiting legal private conduct the employer finds to be dangerous, distasteful or disagreeable." Rodrigues' suit, filed in Suffolk Superior Court, claimed The Scotts Co. violated his rights under Massachusetts' privacy statute, which bars unreasonable, substantial, or serious interference of privacy. Rodrigues' lawyer, Harvey Schwartz, said drug tests can be required if companies believe that employees are either using drugs at work, or if drug use would seriously interfere with their performance. But according to Schwartz, neither of those conditions was met in this case. "Being compelled to provide a urine sample and the information that the sample contains is a violation of his privacy, where it has no relation to his job," he said. Earlier this year, The Scotts Co. instituted a policy forbidding employees from smoking. Twenty states, including Massachusetts, allow companies to refuse to hire smokers and to test employees for nicotine.
After a recent fatal fire in a Missouri group home, state officials have ordered a thorough review of the state's applicable safety laws. Tragically, ten residents of the Anderson Guest House died last week of smoke inhalation from a fire that investigators believe was caused by faulty electrical wiring. State Fire Marshal Randy Cole said investigators had discovered evidence of incorrectly spliced attic wiring in the house, in violation of nationally accepted building codes. Cole noted that Missouri lacks a state building code, and therefore lacks enforcement power over fire hazards in buildings. However, state law does require that all newly constructed residential care homes, and some facilities built before 2000, have sprinkler systems. The Anderson Guest House was exempt from the sprinkler system requirement, as are 61 percent of Missouri's residential care homes. Bill Zieres, Missouri's deputy chief fire marshal, stated, "Statistics show that when sprinkler systems are in locations such as this, it does provide fire protection to the residents and does preserve lives." Department of Health and Senior Services spokeswoman Nanci Gonder said, "We will be looking at how our rules might need to be changed, and certainly we'll be looking at the sprinkler issue." Other states might also review their group home fire safety regulations in response to the tragedy, according to Robert Solomon of the National Fire Protection Association.
New York health inspectors are confiscating more illegal foods from stores that cater to immigrants' exotic tastes. This year, state officials have seized 65 percent more food than in all of 2005, including armadillos in Queens, cow lungs in Brooklyn, and smoked rodent meat in Manhattan. "At one time or another, we've probably seen about everything," stated Joseph Corby, director of New York's Division of Food Safety and Inspection. Working with the U.S. Food and Drug Administration, state regulators have inspected stores and warehouses that sell unlabeled, unlicensed, or uninspected foods, hoping to prevent the spread of food-borne diseases such as salmonella and botulism. But, in ethnically diverse New York City, many immigrants continue to buy and sell illegal fare, from chimpanzee meat to turtles to fish paste. Sung Soo Kim has provided food safety education to the Korean community but notes the difficulty of changing ingrained culinary behaviors. Even so, Corby says education and fines can help to change such behaviors, but, when those are not successful, his division can get court injunctions to close down offending stores. So far this year, New York officials have closed 72 stores for violations of food safety laws. "We either clean them up or close them down," Corby said. Ruiad Nasher, a Bangladeshi immigrant who manages a mini-market in Brooklyn, said, "In Bangladesh, you didn't have all these rules." Nevertheless, Nasher has stopped buying non-USDA approved chickens even though they are cheaper. He explained, "Just for chicken, I don't want to lose my business.
State and local disaster planners are drawing on lessons learned from Hurricane Katrina to ensure that healthcare workers stay safe during an avian influenza pandemic. In North Carolina, heavily armed police officers will control crowds at hospitals, guard vaccine distribution centers, and provide security for doctors and nurses at temporary medical facilities. They will also enforce emergency social distancing measures, including isolating the sick, quarantining persons exposed to infection, and closing public places to stem the spread of the virus. "We'd have to enforce those laws and ordinances just like you do in a natural disaster or a riot," said Wake County Sheriff Donnie Harrison. Across the state, hospital security forces are prepared to implement emergency traffic patterns and restrict access to hospital buildings. They are also focused on the safety of doctors and nurses working outside the hospital. "We learned from [Hurricane] Katrina that you need to go farther out in your planning than your front door," said WakeMed Police Chief Lisa Pryse. Pryse's police force includes more than 50 officers who are also trained to provide basic emergency medical care. Other North Carolina hospitals do not have their own security forces, and will instead rely on local law enforcement agencies. Public health officials worry about local law enforcement agencies' abilities to meet the increased demands required during a pandemic, given estimates that as many as 40 percent of officers may be absent from work. But Sheriff Harrison believes officers' dedication to duty will overcome any workforce shortages.
Because almost half of private sector workers in the United States lack paid sick days, lawmakers across the country are beginning to take the issue more seriously. Particularly hard hit are low-wage workers, of whom 75 percent lack paid sick leave. When they are sick, such employees often just continue going to work, thus risking the spread of illness to others. Nationally, the Family and Medical Leave Act requires companies with 50 or more employees to provide up to 12 weeks of sick leave, but only unpaid sick leave. At the local level, San Francisco voters recently passed a ballot measure -- due to become law February 5 -- requiring companies to provide paid sick leave to all employees. The measure requires companies to provide one hour of paid sick leave for every 30 hours worked, and it covers both part-time and full-time employees. Debra Ness, president of the National Partnership for Women and Families, said San Francisco's new law "really helps add momentum" to the national movement for paid sick days. But Kevin Westlye, executive director of the Golden Gate Restaurant Association, opposed the measure and noted that his organization offered a compromise of five days' paid sick leave in the first and second years of employment, and ten days thereafter. A 2004 Harvard University study revealed that 139 countries provide paid sick leave, with 117 nations providing at least one week annually. Randel Johnson, of the U.S. Chamber of Commerce, observed that Europeans' sick leave is typically subsidized by governments rather than being paid for by employers.
Supporters of Congressional bills promoting electronic health records note the records' potential to improve efficiency of care, while critics worry that privacy rights will be compromised. According to a study by Massachusetts General Hospital and George Washington University, only one in four doctors in the United States used electronic health records in 2005, and less than ten percent of them used electronic records for important tasks such as prescription orders, test orders, and treatment decisions. Experts cite several reasons for the slow pace of the technology's adoption in the United States, including high initial cost of equipment, difficulty communicating among competing systems, and fear of lawsuits. Perhaps the biggest hurdle is the public's concern that private information will be used against them. For example, surveys indicate that most Americans worry that their health insurance records could be used by employers to limit job opportunities. In 1996, Congress addressed health privacy concerns in the Health Insurance Portability and Accountability Act (HIPAA) which criminalized the improper disclosure of private medical information. But critics of HIPAA cite loopholes and say violators are rarely punished. Adam Bosworth, vice president for engineering at Google, said, "There is a huge potential for technology to improve health care and reduce its cost. But companies ... must vigorously protect the privacy of users, or adoption of very useful new products and services will fail."
Last week, a federal judge ruled that the U.S. government illegally discriminated against blind people by printing paper currency in denominations indistinguishable from one another. The decision came after a four-year court battle between the government and the American Council of the Blind. The Council had argued that indistinguishable paper currency was "inaccessible" to blind people, and violated the Rehabilitation Act which prohibits government programs from discriminating against people with disabilities. According to the Council's Day Al-Mohamed, paper money "is one of the biggest parts of everyday life, and we just don't have access to it." The Treasury Department had argued that making paper currency identifiable by touch would be an undue financial burden. Judge James Robertson of the U.S. District Court for the District of Columbia agreed with the Council's arguments and ordered the Treasury Department to begin discussing potential remedies within 30 days. Possible solutions might be producing different paper sizes for different denominations, or using raised numerals or perforated dots to make the bills distinguishable from one another. "Of the more than 180 countries that issue paper currency, only the United States prints bills that are identical in size and color in all their denominations," wrote Robertson.
[Editor's note: In 2003, three million adults with diabetes reported visual impairment. To learn more about CDC's Vision Health Initiative at the Division of Diabetes Translation, visit http://www.cdc.gov/diabetes/projects/vision.htm. To read the text of Judge Robertson's decision in American Council of the Blind v. Henry M. Paulson Jr., visit http://www.dcd.uscourts.gov/opinions/2006/Robertson/2002-CV-0864~12:3:41~12-1-2006-a.pdf.]
A legal theory used in Wales to obtain a settlement for a patient who allegedly contracted methicillin-resistant Staphylococcus aureus (MRSA) at a hospital may be widely replicated. The new approach argues that MRSA is a substance harmful to health, and that, therefore, the Control of Substances Harmful to Health (COSHH) regulations (normally used to protect building site workers from harmful chemicals) also apply to hospital-acquired MRSA infections. For a plaintiff to win a case under the COSHH regulations, she must prove she did not have MRSA prior to admission to the hospital, that the treatment she underwent was not ordinarily linked to infection, and that she suffered identifiable health consequences. If the plaintiff proves these three points, then the burden of proof switches to the defendant (usually the National Health Service [NHS] trust overseeing the hospital in question) which must show that it had robust infection control policies in place at the time. Yvonne Agnew, head of clinical negligence at the law firm Leo Abse and Cohen, said, "There is a huge amount of MRSA-related suffering out there and it has always been enormously frustrating for clinical negligence lawyers that it has been difficult to establish a breach of duty in medical care. But now it will be a case of the hospital's duty that will be lacking, not medical care. I believe this could open the floodgates for more claims." Increased claims could force the NHS trusts to pay greater premiums to the Welsh Risk Pool, which covers legal costs on behalf of NHS.
Georgia: Supreme Court rules asbestos claims statute cannot be applied to pending cases
Mississippi: Supreme Court rules companies not liable for accidents
South Carolina: Law requires districts to define bullying, outline procedures
Texas: Foster parents prohibited from smoking in homes, cars beginning January 1
Virginia: Chairman nixes plans to stop home-cooked shelter meals
National: Despite safety law, disease rates remain high
National: Poll reveals confidence in health departments shaken with food illness
Britain: Smoking in public banned from July 2007
Canada: Scam artist plays on influenza fears
Canada: Nova Scotia bans smoking in all indoor public areas, workplaces, patios
China: HIV testing to begin January 1
Hong Kong: Food scares demonstrate need for new powers
Scotland: Restrictions on acupuncture, tattoos, piercings eased
Thailand: Public Health Ministry announces mass production of generic drug
"In restricting trans fat, we are not regulating commerce -- we are regulating food preparation at the point of consumption, a point the Food Drug and Cosmetic Act never gets to. This is not about food manufacturing, food transportation, or food distribution."
-- Wilfredo Lopez, General Counsel for Health, New York City Department of Health and Mental Hygiene, on his city's new trans fat regulation.
Lawyers played a key role in yesterday's action by the New York City Board of Health to restrict trans fat from foods prepared at city restaurants. In an exclusive interview with the CDC Public Health Law News, Wilfredo Lopez, General Counsel for Health at the New York City Department of Health and Mental Hygiene, said a huge amount of preparatory legal work was needed before the rule was released to the public on September 26. Lopez said he and a small group of Health Department lawyers began legal research on the restriction well before the rule was proposed -- the research centered on the Board's legal authority to adopt it and on possible ways the new rule could be challenged in court. Early on, the team determined that the restriction would not be an attempt to regulate food manufacturing, processing, distribution, or transportation, but would aim only at the preparation of food at the retail (restaurant) level. Eventually, the team created a detailed legal memorandum and gave it to the Board under attorney-client privilege. Lopez said the main purpose of the memo was to provide a "level of comfort" to the Board that the new regulations were well within the city's legal authority.
"We had to look into a lot of issues that local health departments usually don't need to delve into," Lopez said. The three most prominent issues involved the Interstate Commerce Clause, the federal Supremacy Clause, and federal preemption under the Food Drug and Cosmetic Act. Lopez said that, if the restaurant industry does challenge the trans fat regulation, one or more of those issues could be litigated. But he is confident that the city would prevail.
Lopez and his legal team also had to contend with many practical issues, including lawyer staffing and workflow. Most of the work was done by three staff attorneys, Lopez's deputy, and Lopez himself, and the workload ran high. For example, Lopez said the legal team had to review the comments submitted on the proposal. "The comments were mostly in favor, but there were some in opposition, and the most substantive ones came from the National Restaurant Association," Lopez said. Some of the comments staked out legal arguments against the restriction that challengers might use in court. Others centered more on practical problems that commenters claimed the restriction would create for restaurants. Lopez said any litigation around the new rule would be handled by the city's Law Department.
Lopez is aware that other cities are considering trans fat bans. He advised them to be well-versed on issues of interstate commerce and federal preemption. "The food industry is very reluctant to be governed by local rules -- especially the chain restaurants. They are concerned about 'Balkanization' of food preparation rules, because they take a national perspective," he said. However, Lopez feels strongly that, "State and local police powers are not, and should not be, preempted, especially when it comes to provisions which regulate food preparation at the point of consumption for the protection of the public's health."
Lopez said the trans fat rule is probably the last big issue he will work on as a Health Department employee. He is retiring at the end of December after 27 years as Deputy and then General Counsel. His work on the trans fat rule was some of the most extraordinary he has been involved in through his career. Even in his last month as an employee, Lopez said there have been surprises. At yesterday's meeting of the Board of Health, the trans fat restriction was only one of the issues on the agenda. Another rule involved unleashed dogs in city parks. While the trans fat restriction generated about 2,200 comments, the leashing rule generated over 13,000. The meeting concluded when Health Commissioner Thomas Frieden and the Board of Health passed a resolution recognizing Mr. Lopez as Counsel Emeritus to the Health Department and the Board of Health.
Welcome to the Monthly Quiz. Each quiz contains questions from News stories and other content published in the previous month. Submit your answers by email to rweiss@cdc.gov. The first reader who answers all questions correctly will be recognized in an announcement in the News (if you prefer to be not to be recognized by name, please let us know). Check next week's issue of the News for the correct answers. The November Quiz covers the following issues: November 1, November 8, November 15, and November 22 (to see past issues, visit http://www2a.cdc.gov/phlp/dailynews/default.asp.)