The status of legal authority for injury prevention practice in state health departments.

Despite the potential for public health strategies to decrease the substantial burden of injuries, injury prevention infrastructure in state health departments is underdeveloped. We sought to describe the legal support for injury prevention activities at state health departments. We searched the Lexis database for state laws providing authority for those activities, and categorized the scope of those laws. Only 10 states have authority that covers the full scope of injury prevention practice; in the others, legal authority is piecemeal, nonspecific, or nonexistent. More comprehensive legal authority could help health departments access data for surveillance, work with partners, address sensitive issues, and garner funding. Efforts should be undertaken to enhance legal support for injury prevention activities across the country.

State courts and public health: building partnerships to enhance preparedness.

Laws and regulations can facilitate or impede emergency preparedness and response activities. State legislators, judges, and lawyers play critically important roles in creating and interpreting laws that affect the ability of public health practitioners and their partners to effectively respond to emergencies. In an age when political unrest, global travel, and emerging biological threats can combine to create social and economic havoc worldwide, it is critical that those responsible for upholding the rule of law during emergencies understand the law and its implications. In 2003, the University of Pittsburgh Center for Public Health Preparedness (UP-CPHP) created a Preparedness Law and Policy Program to advance legal preparedness for public health emergencies across Pennsylvania and the nation. To achieve this goal, UP-CPHP has partnered with local, state, and national organizations. In the course of these activities, Pennsylvania judges, the Administrative Office of Pennsylvania Courts, UP-CPHP, and the Centers for Disease Control and Prevention's Public Health Law Program have developed a strong and enduring collaborative relationship that has put the Pennsylvania judiciary in a better position today to plan for and respond to a public health crisis than it has been at any other point in its history. The tools and resources developed through this collaboration can readily be adapted to assist other jurisdictions nationwide in their efforts to ensure that their judicial systems are similarly prepared.

Public health legal preparedness in Indian country.

American Indian/Alaska Native tribal governments are sovereign entities with inherent authority to create laws and enact health regulations. Laws are an essential tool for ensuring effective public health responses to emerging threats. To analyze how tribal laws support public health practice in tribal communities, we reviewed tribal legal documentation available through online databases and talked with subject-matter experts in tribal public health law. Of the 70 tribal codes we found, 14 (20%) had no clearly identifiable public health provisions. The public health-related statutes within the remaining codes were rarely well integrated or comprehensive. Our findings provide an evidence base to help tribal leaders strengthen public health legal foundations in tribal communities.

Mutual aid agreements: essential legal tools for public health preparedness and response.

Mutual aid is the sharing of supplies, equipment, personnel, and information across political boundaries. States must have agreements in place to ensure mutual aid to facilitate effective responses to public health emergencies and to detect and control potential infectious disease outbreaks. The 2005 hurricanes triggered activation of the Emergency Management Assistance Compact (EMAC), a mutual aid agreement among the 50 states, the District of Columbia, Puerto Rico, and the US Virgin Islands. Although EMAC facilitated the movement of an unprecedented amount of mutual aid to disaster areas, inadequacies in the response demonstrated a need for improvement. Mutual aid may also be beneficial in circumstances where EMAC is not activated. We discuss the importance of mutual aid, examine obstacles, and identify legal "gaps" that must be filled to strengthen preparedness.

The courts, public health, and legal preparedness.

The judicial branch's key roles, as guardian of civil liberties and protector of the rule of law, can be acutely relevant during public health emergencies when courts may need to issue orders authorizing actions to protect public health or restraining public health actions that are determined to unduly interfere with civil rights. Legal preparedness for public health emergencies, therefore, necessitates an understanding of the court system and how courts are involved in public health issues. In this article we briefly describe the court system and then focus on what public health practitioners need to know about the judicial system in a public health emergency, including the courts' roles and the consequent need to keep courts open during emergencies.

Prescription drug laws, drug overdoses, and drug sales in New York and Pennsylvania.

Drug overdose mortality nearly doubled in the United States from 1999 to 2004, with most of the increase due to prescription drug overdoses. Studying mortality rates in states that did not experience such increases may identify successful prescription overdose prevention strategies. We compared New York, a state that did not experience an overdose increase, with its neighbor, Pennsylvania. New York and Pennsylvania had prescription drug monitoring programs (PDMPs), but New York's PDMP was better funded and made use of serialized, tamperproof prescription forms. Per capita usage of the major prescription opioids in New York was two-thirds that of Pennsylvania. The drug overdose death rate in Pennsylvania was 1.6 times that of New York in 2006. Differences between New York and Pennsylvania might be due to the regulatory environment in New York State.

Law, liability, and public health emergencies.

According to many experts, a public health emergency arising from an influenza pandemic, bioterrorism attack, or natural disaster is likely to develop in the next few years. Meeting the public health and medical response needs created by such an emergency will likely involve volunteers, health care professionals, public and private hospitals and clinics, vaccine manufacturers, governmental authorities, and many others. Conducting response activities in emergency circumstances may give rise to numerous issues of liability, and medical professionals and other potential responders have expressed concern about liability exposure. Providers may face inadequate resources, an insufficient number of qualified personnel, overwhelming demand for services, and other barriers to providing optimal treatment, which could lead to injury or even death in some cases. This article describes the different theories of liability that may be used by plaintiffs and the sources of immunity that are available to public health emergency responders in the public sector, private sector, and as volunteers. It synthesizes the existing immunity landscape and analyzes its gaps. Finally, the authors suggest consideration of the option of a comprehensive immunity provision that addresses liability protection for all health care providers during public health emergencies and that, consequently, assists in improving community emergency response efforts.