Profiles in Public Health Law

Peter Baldridge (posted August 16, 2005)

Adams: "My educational background is a B.A. in 1991 from Luther College, in Decorah Iowa, and a J.D. from the University of Iowa College of Law in 1994. I work for the Iowa Attorney General and am legal counsel for the Iowa Department of Public Health. I started at the AG's Office eleven years ago, and was offered the opportunity to represent the Department of Public Health about seven years ago. I jumped at the chance to represent an agency with so many varied and interesting programs – I represent over 100 different programs, all with important missions. I am amazed at the breadth and reach of public health – the public tends to think of public health solely as the provision of health care services to the indigent, but public health is really the safety net which ensures that the entire population is healthy.  From overseeing newborn screening to investigating communicable disease outbreaks to preparing for potential acts of bioterrorism, the range is much broader than people realize, and public health is at the forefront. I love the quote from C. Everett Koop that ‘health care is vital to all of us some of the time, but public health is vital to all of us all of the time.’"

CDC Public Health Law News: Please describe a typical workday.

Adams: "Interesting question ... the issues that arise daily are diverse and challenging. A workday for me might involve a morning meeting with one of the health professional licensing boards I represent, where legal issues tend to revolve around profession-specific issues and disciplining licensees for issues like sexual misconduct or incompetence. Afternoons are usually spent responding to client queries regarding issues like contracting, statutory interpretation, or drafting administrative regulations. My job almost always involves significant contact with clients, and I've found the public health staff I work with and for to be committed and bright, and truly invested in the health of all Iowans. They are a joy to represent, and not all attorneys can say that about their clients, I promise you!"

CDC Public Health Law News: What is the most important thing you are working on?

Adams: "This week I have two top priorities: Finishing a handbook for the Director of the Department of Public Health, which outlines legal authorities in the event of a public health disaster. It includes our recently-revised public health disaster law, quarantine law, and other state laws, and also includes templates for disaster proclamations, quarantine orders, court petitions and executive orders. We're also burning it to CD, so staff can have it at their disposal, in event that we have an actual disaster and I'm not accessible.

My second priority involves confidentiality issues regarding the release of information. We're in the process of redrafting confidentiality laws to better define issues in this area, and clarify the intersection of federal, state, and case law.

Although my schedule doesn't often allow it, I like projects where I'm more proactive rather than responding to the fire of the day."

CDC Public Health Law News: Describe any personal information, hobbies, or interests you care to share.

Adams: "I have three small children, ages 7, 4, and 2, so most activities revolve around them.

I've just run my first 20k, and am hoping to complete a sprint triathlon in July.

I also love old houses and reading, and have a small library in our 1920's home, where I can combine both passions."

CDC Public Health Law News: If you were not working in public health law, what would you like to do?

Adams: "I'd love to run a book store with my husband. We're both really into reading, so being around him and books all day would be a perfect combination."

CDC Public Health Law News: What are your favorite books and what have you read lately?

Adams: "I would say that my two favorites are "Stones from the River" by Ursula Hegi, an elegant, beautifully written novel; and "Prodigal Summer" by Barbara Kingsolver – a must read for anyone with a love of nature. I'm currently reading "Don't Think of an Elephant" by George Lakoff, a discussion of the role and use of language in politics – a short, interesting read for summer."
 

Lopez: "I graduated from the City College of NY, with a BA in 1973, and from Brooklyn Law School with a JD in 1976. After doing criminal defense for the Legal Aid Society in the Bronx and clerking for a Bronx Civil Court judge, I decided to do something new. In 1979, I started my career in the NYC Department of Health as a staff attorney, where I liked doing contracts for correctional health services and methadone treatment programs, and working on regulatory issues such as radiation control. In 1980, I was promoted to Deputy General Counsel and was soon immersed in the AIDS epidemic, dealing with legal and policy issues such as epidemiological investigations involving 'patient 0,' confidentiality of AIDS and HIV information, and sexual activities in public places like theaters, baths, and clubs.

The 1990s were also exciting times for public health issues. In 1992, I was appointed General Counsel to the Department of Health, in the midst of an epidemic of drug resistant TB. Issues of isolation, quarantine, and public health detention came to the fore, resulting in amendments to the New York City health code to provide due process protection to detainees. In 1999, West Nile Virus highlighted the intersection of public health and environmental protection laws.

Of course, the attacks on the World Trade Center and the dissemination of anthrax in the fall of 2001 brought yet another dimension to public health law. I must say that my route to and through public health law has given me the opportunity to be involved in some of the most significant social, public health and legal issues of our age. It's been a fascinating journey."

CDC Public Health Law News: Please describe a typical workday.

Lopez: "Unfortunately, a typical work day now requires a constant struggle to keep up with email. I say unfortunate because too often the technology allows for frivolous questions, whereas legal advice needs a more contemplative and considered approach.

But that is my own pet grievance. Aside from being tied to the computer, most days involve several meetings with high level policy makers, both inside and outside the department. What I enjoy the most is discussing live issues with my legal staff, and providing direction to the lawyers who work with me. I still enjoy rolling up my sleeves and doing research and writing of opinions, or drafting a contract, regulation, or piece of legislation."

CDC Public Health Law News: What is the most important thing you are working on?

Lopez: The most important thing is the updating and thorough revision of the NYC health code - a project that I've been interested in for years and which should come to fruition in the next year or so. It's a long process.

The issues presented by the possibility of drug resistant and rapidly developing strains of HIV, and the world of electronic medical records are also of great importance."

CDC Public Health Law News: Describe any personal information, hobbies, or interests you care to share.

Lopez: "A lot of 'free' time on weekends is devoted to pushing the lawnmower and puttering around the house. My wife and I enjoy dancing to Latin music."

CDC Public Health Law News: If you were not working in public health law, what would you like to do?

Lopez: "That's a hard question, since it's all I've done for over a quarter century, and I enjoy it so much. I used to think about entertainment law, but my inner soul still fantasizes about playing percussion (the timbales) in a Latin band. I exercise that fantasy by banging away on my bongos at home - it's great therapy."

CDC Public Health Law News: What are your favorite books and what have you read lately?

Lopez: "I have to say that my favorite book is the one I collaborated on with many public health colleagues, Law in Public Health Practice. In terms of everyday reading, I tend toward lighter subjects, like science fiction, although since the passing of Asimov, the genre just isn't the same. I lean toward detective stories and murder mysteries - anything to quickly glide me into a nap on the subway or a good night's sleep."
 

CDC Public Health Law News: Is there anything else you'd like to add?

Lopez: "One thing I often say is that public health law is just a fascinating and interesting field of law, and the way I can tell it still holds my interest is that there's never been a Sunday night or an end of a vacation where I've said 'oh, shucks, I've got to go to work tomorrow' - I've never had that feeling."
 

The organization I work for, the Genesee County Health Department (GCHD), and the corporation/local government in which the Health Department is nested, are both created and specifically authorized by Michigan law. And Michigan's Public Health Code provides very powerful authorities to the GCHD and its Boards including, among other things, the authority to create law to protect and promote the public's health and to take actions to prevent and control epidemics and events which present imminent threats to the public's health.  With this authority, for example, our local Boards have adopted and authorized regulations governing water supplies and wells, sewage disposal, tobacco use and sales, nuisances, inspections, bathing beaches, and swimming pools.  To balance these authorities, we are also bound by a set of administrative rules and procedures to protect people and businesses who interact with us from arbitrary and willful behavior on our part. At the service end of our business, we give law its form and expression by enforcing it and delivering services.  We help people adopt behaviors and make decisions which are consistent with the law's intent."

CDC Public Health Law News: Please describe a typical workday.

Pestronk: "The scope of work for someone in local governmental public health is eclectic...and the work I do on a daily basis reflects this.  A typical day involves a crisis of some sort like the loss or gain of funding or staff, a restaurant closure or food-borne outbreak, loss of power or water or phone systems at one of the Department's buildings.  It typically involves lots of e-mail traffic with staff, representatives from other organizations, or with Associations with which I am active, about problems which have arisen and require some consult, solution, or decision.  It involves phone calls from the media, to gain perspective on a story or to learn about departmental or extra-departmental situations, from constituents to complement or complain, or from elected officials to request that the Department examine a specific situation which has been brought to their attention.  There are constant meetings on a range of personal, behavioral, community, and environmental health issues with a diverse group of local people.  Sometimes there is a brief stop for lunch either at my desk, at the weekly Rotary meeting, or occasionally at a restaurant.  A typical day includes preparation for meetings, of agendaeagendas, memos, and reminders to and from staff. Sometimes there is time for a little bit of reading between meetings and there is always multi-tasking on a range of longer-range initiatives which get moved along in an incremental fashion over time.  There is always a decision at the end of the day about what to take home for a closer read and a look at web news before leaving the office."

CDC Public Health Law News: What is the most important thing you are working on?

Pestronk: "Improving the public's health requires work with people and paper in a number of areas simultaneously so there is never only one important issue.  As the director of the Health Department I administer the important work of an organization of 180 people with a budget of $25 million. Each of these staff work on an important issue.  As health officer I am working to assure access to primary care for about 30,000 County residents through a local non-profit organization, beginning to work with a consultant to consider ways in which the emergency medical services system in the County might be reorganized and the services delivered differently, and finishing a phase of activity which will result in the redesign of the County's medical examiner system.  I'm also working with State legislators and others in the community to try to prevent the loss of state funds for hearing and vision screening services now delivered by the Department to school age children. Finally, I am also working with the National Association of County and City Health Officials on two projects: the first to better profile characteristics of local health departments and those who work for, and with, them; the second to implement a recognition program for local health departments who have met standards and criteria which demonstrate preparedness for emergencies.  I've also helped to create the Public Health Law Association, an international organization which promotes healthy people in healthy communities through dialogue, partnerships, education and research in public health law."

CDC Public Health Law News: Describe any personal information, hobbies, or interests you care to share.

Pestronk: "My wife and I are taking ballroom dance lessons...something which has been on our to-do list for a long time and is finally getting attention.  I spend time on my vegetable and perennial gardens from Spring to the Fall and of course push a lawnmower around at least once a weekend from May through November.  I either run or skip rope in the mornings and lift weights in the evening.  I dabble periodically on steel string guitar usually getting distracted by other things just about the time I feel like I'm making some progress.  My son is just finishing college and my daughter finishing her first year in college.  I've really enjoyed being with them as they have grown into very talented and responsible young adults.  And this time of the year I'm trying to watch the Detroit Pistons win another championship."

CDC Public Health Law News: If you were not working in public health law, what would you like to do?

Pestronk: "A professional surfer or lead guitar in a rock or jazz band."

CDC Public Health Law News: What are your favorite books and what have you read lately?

Pestronk: "Most recent book read: The Rule of Four. Reading now: Hard Times by Dickens; a collection of short stories, Telling Tales; and whatever in the current issue of the New Yorker magazine peaks my curiosity."
 

Keating: "I have been at the Division of Public Health for two and a half years.  Out of law school, I started as a staff attorney for the Georgia Council of Juvenile Court Judges, a state judicial branch agency that serves as a representative body of all juvenile courts in Georgia.  As a staff attorney, I handled legal issues facing any judge in the state on a particular day; foster children, children with special needs, etc.  I realized that providing services to children that are in their best interest was a multi-agency team effort with a lot of cross-section between the Division of Family and Children Services, Public Health, and the Department of Education.  That was my first introduction to the vital role of public health, and I became interested in it. Ultimately, I left the courts to accept this job in public health - a move that my family appreciated.  My mother is a nurse, and my twin sister is a physician so I wanted to do something in the medical field.  I realized that the field of public health probably offered the most effective way to work in the fields of law and medicine and still be in the public sector."

CDC Public Health Law News: Please describe a typical workday.

Keating: "There is no typical workload.  A typical day is extremely fast paced, and the priorities of the day are based on whatever situation confronts our public health staff that are in the community.  I don't drive the priorities; they are based on the needs of the community.  We react to that and provide legal guidance.  For example, this morning my work includes providing guidance on whether there is legal justification to grant a waiver to our environmental health rules and regulations.  Another issue centers on whether Public Health has the legal authority to enter into rental property to conduct an environmental investigation to check lead levels in that home.  Another task is determining what legal tools Public Health can use to ensure more consistent notifiable disease reporting from health care providers.  Later this afternoon, I'm looking at Public Health's authority to access school records to determine whether children are getting proper hearing screenings, and I will also be completing a progress report on the assessment of our public health laws and whether they are sufficient to enable Public Health to respond effectively to an emergency.  It's a dynamic workplace that requires flexibility.  I appreciate the fast pace and that it's event-driven."

CDC Public Health Law News: What is the most important thing you are working on?

Keating: "Every program is so important and carries out vital functions, and each has reason to feel its work is the most important.  In the past legislative session, Public Health passed its Tuberculosis (TB) bill.  It revises GA statutes to lengthen the amount of time that Public Health can confine TB patients who persistently do not adhere to treatment. The current statute only allows confinement for up to six months, while CDC recommendations suggest that a patient with multi-drug resistant TB be confined for a minimum of 18 to 24 months for adequate treatment.  Public Health asked to lengthen the time to two years to meet the CDC recommended timeframe.  The change was just passed by the legislature, and I have been answering questions from the Governor's office about this change.  I have also been working with TB program staff to provide information to address any concerns.  We hope the Governor will sign SB 56 into law.

A long-term priority is the work being done by our state isolation and quarantine work group; the group has been in existence for two years.  In 2002, the Georgia legislature required Public Health to create rules and regulations for quarantine and isolation during a public health emergency.  The work group was created because policies and procedures have to be in place before adopting these rules and regulations.  The group includes different professionals in public health, including health directors, nurses, hospital administrators, physicians, epidemiologists, etc.  We created working drafts for voluntary agreements and draft orders for health officers.  This work is a priority because it's important to have a formal process in place for restrictive measures like quarantine and isolation that gives public health officials clear authority to act during a public health emergency; it's equally important to have this in place to insure that the public's due process rights are protected during such a time."

CDC Public Health Law News: If you were not working in public health law, what would you like to do?

Keating: "I would probably be working in federal law enforcement.  I have always been interested in that field.  I did an internship with the general counsel's office at the ATF during law school.  Since 9/11, a lot of public health includes providing legal guidance on public health emergency laws, the Governor's emergency powers, preparation and response.  In doing that work, I come into contact with local, state, and federal law enforcement officials.  So going into federal law enforcement would be a natural career progression for me."

CDC Public Health Law News: What are your favorite books and what have you read lately?

Keating: "To Kill a Mockingbird, by Harper Lee.  I feel that Atticus Finch is one of the most courageous lawyer characters in literature.  The book's main message is that everyone should be considered equal under the law regardless of race.  When Finch addresses the jury, he makes a moving oratory on this point, 'The defendant is not guilty, but someone in this courtroom is....'  It's a very effective indictment against racism in the court room.  I am currently reading The Games Do Count, by Brian Kilmeade of Fox News.  The book profiles different public figures, and talks about the role that sports played in their lives.  I've played sports my entire life and I believe that sports provide a great avenue to build character, leadership, and respect.  The book allows you to see a side of public figures such as Condoleeza Rice and Jack Welch that you wouldn't otherwise have an opportunity to see."
 

CDC Public Health Law News: Please describe a typical workday.

Ragland: "There is no typical day at the office because the need for legal advice is event-driven.  Many times, especially in disease control matters, the client wants to know what they can or cannot do, right then.  Because I am relatively new to the practice, I face many of these issues for the first time.  Recent issues that have confronted our county's public health department range from the confidentiality of reports of hospital acquired infections to a distemper outbreak among horses in a rural part of the county.  Other various issues that I worked on in the past year have been: how to best treat an infectious MDR TB patient that would not stay in his hospital room; the effect of the Compassionate Use Act (medical marijuana) on the county's Department of Health Services; and what type of license is required to drill a water well in California.  So, in my practice, there is a wide variety of issues that sometimes need immediate answers, which is more than enough to keep me busy."

CDC Public Health Law News: What is the most important thing you are working on?

Ragland: "I think the most important thing I do is to advise the local health officer and his staff on his powers and duties to control the spread of diseases within the county.  Simply put, I advise them on what they can and cannot do."

CDC Public Health Law News: If you were not working in public health law, what would you like to do?

Ragland: "If I were not doing this, I likely would have eventually matriculated into one of three things: a bartender, a basketball coach, or a writer.  Of course, everyone in LA has screenplay to pitch."

CDC Public Health Law News: What are your favorite books and what have you read lately?

Ragland: "The Hunchback of Notre Dame, by Victor Hugo, or A Confederacy of Dunces, by John Kennedy Toole.  The book I have read most recently was Life on the Mississippi, by Mark Twain.  It contains a passage describing the effects of a yellow fever outbreak in a town in Missouri".

Quote by Robert E. Ragland: "In my job, you gain an appreciation for the real interdependencies of community, and how public health law touches, either directly or tangentially, every aspect of people's lives.  I do think it is important to remember that it is the goal of a community to strive for the good of its members, which clearly includes the public's health."