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.
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.
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.
A community's abilities to promote health and maximize its response to public health threats require fulfillment of one of the four elements of public health legal preparedness, the capacity to effectively coordinate law-based efforts across different governmental jurisdictions, as well as across multiple sectors and disciplines. Government jurisdictions can be viewed “vertically” in that response efforts may entail coordination in the application of laws across multiple levels, including local, state, tribal, and federal governments, and even with international organizations. Coordination of legal responses to public health emergencies also may involve a horizontal dimension comprising numerous and diverse sectors, such as public health, public and private health care, emergency management, education, law enforcement, the judiciary, and the military.Although responses to many acute health threats can implicate multiple jurisdictions and sectors, the jurisdictional and sectoral dimensions of legal preparedness are complex and may vary substantially by the nature of a threat, its geographic and geopolitical extent, and the operational response demanded.
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.
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