public health systems research creating the evidence for policy february 8, 2006
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Public Health Systems Research Creating the Evidence for Policy February 8, 2006 Legal Issues Concerning Volunteer Health Professionals in Public Health Emergencies. James G. Hodge, Jr., J.D., LL.M. - PowerPoint PPT PresentationTRANSCRIPT
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Public Health Systems ResearchPublic Health Systems ResearchCreating the Evidence for Policy Creating the Evidence for Policy
February 8, 2006
Legal Issues Concerning Volunteer Health Professionalsin Public Health Emergencies
James G. Hodge, Jr., J.D., LL.M. Associate Professor, Johns Hopkins Bloomberg School of Public Health;
Executive Director, Center for Law & the Public’s Health at Georgetown and Johns Hopkins Universities
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
2
Principal Objectives
• Assessing the Legal Environment in Public Health Emergencies• Legal Triage During Emergencies• Legal Issues Underlying the Deployment
and Use of Volunteer Health Professionals (VHPs)
• Declaration of States of Emergency• Licensure Reciprocity• Civil Liability and Immunity• Protections from Harms
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
3
Assessing the Legal Environment in Public Health Emergencies
Compacts
Cases
Policies Regulations
Statutes
Constitutions
Treaties
Types of Laws
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
4
Assessing the Legal Environment in Public Health Emergencies
• Laws pervade emergency responses at every level of government:
• They dictate the nature of what constitutes a public health or other emergency
• They help create the infrastructure through which emergencies are detected, prevented, and addressed
• They authorize the performance (or nonperformance) of various emergency responses by a host of actors
• They determine the extent of responsibility for potential or actual harms that arise during emergencies
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
5
The Convergence of Governments in Public Health Emergencies
Community
City
County Tribal
State
National
International
Govern-ment
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
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The Convergence of Partners in Public Health Emergencies
Emergency Management
Private Industries
NGOs
Hospitals
National Security
Law Enforcement
Environment
Public Health
Partners
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
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The Convergence of Specific Actors in Public Health Emergencies
Military
Volunteers
HealthAdministrators
Health CareWorkers
Federal Agents
Law Enforcers
Lab Directors
Public HealthOfficials
Actors
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
8
Legal Triage During Public Health Emergencies
Government
PartnersActors
Legal Triage in PHEs – Public health law in real-time
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
9
State of Emergency
Once an emergency has
been declared, the legal
landscape changes.
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
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The Center’s Model State Emergency Health Powers Act (MSEHPA)
Government is vested with specific and expedited powers to facilitate emergency responses
Individuals are bestowed special protections and entitlements
State medical licensure requirements may be waived
Responders may be protected from civil liability
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
11
The Use and Deployment of VHPs to Meet Surge Capacities During Emergencies
During Hurricane Katrina, there quickly arose a significant need for additional health personnel to meet patient surge capacities
Volunteer medical personnel responded to this need through multiple routes – federal, state, local, and private sector
Through its Emergency Systems for the Advance Registration of Volunteer Health Professionals (ESAR-VHP) program, HRSA and state partners deployed thousands of pre-vetted VHPs to the Gulf Coast states
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
12
The Use and Deployment of VHPs – Legal Issues
1) Declaration of States of Emergency
2) Licensing of VHPs
3) Civil Liability, Immunity, and Indemnification
4) Protections from Harms – Workers’ Compensation
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
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Emergency Declarations
What is the effect of an emergency declarations pertaining to VHPs?
VHP deployment, uses, authorities, liabilities, immunities, and protections from harm all vary depending on (1) the type of emergency declared and (2) the level of government making the declaration
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
14
States That Define “Emergency”Among 30 Phase I & II ESAR-VHP States
HIHIAKAK
CACA
OROR
WAWA
IDID
MTMT
TXTX
SDSDWYWY
NVNV
OKOK
KSKS
NENE
COCO
NMNMAZAZ
UTUT
NDND
SCSC
MNMN
WIWI
IOIO
MOMO
ARAR
LALA
VAVA
NCNC
GAGA
FLFL
ALALMSMS
ILILWVWV
KYKY
TNTN
NYNY
PAPA
ININ OHOH
MIMI
DEDENJNJ
CTCTRIRI
MAMA
MEME
DCDCMDMD
NHNHVTVT
PR - PR - (Puerto Rico)(Puerto Rico)VI - VI - (U.S. Virgin Islands)(U.S. Virgin Islands)
““Emergency” or similar termEmergency” or similar termdefined in state statutesdefined in state statutes
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
15
States That Define “Disaster”Among 30 Phase I & II ESAR-VHP States
HIHIAKAK
CACA
OROR
WAWA
IDID
MTMT
TXTX
SDSDWYWY
NVNV
OKOK
KSKS
NENE
COCO
NMNMAZAZ
UTUT
NDND
SCSC
MNMN
WIWI
IOIO
MOMO
ARAR
LALA
VAVA
NCNC
GAGA
FLFL
ALALMSMS
ILILWVWV
KYKY
TNTN
NYNY
PAPA
ININ OHOH
MIMI
DEDENJNJ
CTCTRIRI
MAMA
MEME
DCDCMDMD
NHNHVTVT
PR - PR - (Puerto Rico)(Puerto Rico)VI - VI - (U.S. Virgin Islands)(U.S. Virgin Islands)
““Disaster” or similar term Disaster” or similar term defined in state statutesdefined in state statutes
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
16
States That Define “Public Health Emergency”Among 30 Phase I & II ESAR-VHP States
HIHIAKAK
CACA
OROR
WAWA
IDID
MTMT
TXTX
SDSDWYWY
NVNV
OKOK
KSKS
NENE
COCO
NMNMAZAZ
UTUT
NDND
SCSC
MNMN
WIWI
IOIO
MOMO
ARAR
LALA
VAVA
NCNC
GAGA
FLFL
ALALMSMS
ILILWVWV
KYKY
TNTN
NYNY
PAPA
ININ OHOH
MIMI
DEDENJNJ
CTCTRIRI
MAMA
MEME
DCDCMDMD
NHNHVTVT
PR - PR - (Puerto Rico)(Puerto Rico)VI - VI - (U.S. Virgin Islands)(U.S. Virgin Islands)
““Public health emergency” Public health emergency” or similar term defined in or similar term defined in state statutesstate statutes
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
17
States That Define “Public Health Emergency” and “Emergency” or “Disaster”Among 30 Phase I & II ESAR-VHP States
HIHIAKAK
CACA
OROR
WAWA
IDID
MTMT
TXTX
SDSDWYWY
NVNV
OKOK
KSKS
NENE
COCO
NMNMAZAZ
UTUT
NDND
SCSC
MNMN
WIWI
IOIO
MOMO
ARAR
LALA
VAVA
NCNC
GAGA
FLFL
ALALMSMS
ILILWVWV
KYKY
TNTN
NYNY
PAPA
ININ OHOH
MIMI
DEDENJNJ
CTCTRIRI
MAMA
MEME
DCDCMDMD
NHNHVTVT
PR - PR - (Puerto Rico)(Puerto Rico)VI - VI - (U.S. Virgin Islands)(U.S. Virgin Islands)
““Emergency”, “disaster”, andEmergency”, “disaster”, and““public health emergency” (or public health emergency” (or similar terms) defined in state similar terms) defined in state statutesstatutes
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
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Multiple Levels of Emergency Declarations
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
Local emergency or disaster
Local public health emergency
State emergency or disaster
State public health emergency
Federal “FEMA” emergency
Federal “HHS” public health emergency
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Regulation of Professionals
• When can VHPs practice across state lines?Emergency declarations and other laws provide for portability of licensure, certification, and credentialing for some volunteer medical responders
Some health practitioners have increased portability rights under state-level agreements like the Emergency Management Assistance Compact (EMAC) or other non-emergency reciprocity agreements (e.g., Nurse Licensure Compact)
Additional practitioners may benefit from temporary federal status under multiple legal routes
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
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Civil Liability, Immunity, and Indemnification
• Major questions:
Who may face civil liability?
What types of actions are subject to civil liability?
What are the legal protections from civil liability?
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
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Civil Liability
• Who may face civil liability?
Volunteer health professionals
Health care entities supplying VHPs
Health care entities hosting VHPs
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
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Civil Liability
• Legal theories include:
Negligence/malpractice
Intentional torts
Privacy
Misrepresentation
Discrimination
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
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Civil Liability
Liability Risks to VHPs and Supplier/Host Entities
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
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Liability Protections
Mutual Aid Agreements
Good Samaritan
Acts
Federal VPA
State VPAs
EMACImmunities
JCAHO Standards/Policies & Practices
MOUs
Insurance Coverage
State EHPA
Civil Liability Protections
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
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Protection of VHPs from Harms - Workers’ Compensation
• Key Questions:
Who is an employee for the purposes of workers’ compensation? – not typically VHPs
Who is the employer of volunteers? Their host? Their existing employer? Government? NGOs?
When is a volunteer acting within the scope of her employment? – a key to workers’ comp coverage
When is a volunteer “injured” in the course of emergency responses? Consider disease outbreaks
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
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Conclusions
• Legal preparedness is an essential component to detecting, preventing, and responding to public health emergencies
• Laws – their development, interpretation, and application – during emergencies have the potential to facilitate (or derail) effective public health responses
• The key is to create a favorable legal environment before, during, and after legal triage through ongoing communication, planning, and amendments
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
27
Final Thoughts
• For more information about these issues or the Center please contact me or visit our website at: www.publichealthlaw.net
• For specific information regarding the Center’s VHP responses on Hurricane Katrina, see our website at: www.publichealthlaw.net/ Research/Katrina
• Thank you!
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights
The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities
CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights