Health Policy Tracking Service

As of April 22, 24 states plus the District of Columbia are in regular session. These states are Alaska, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Iowa, Kansas, Massachusetts, Michigan, Minnesota, Missouri, New Hampshire, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont and Wisconsin.

Alabama, Arizona, Florida, Georgia, Idaho, Indiana, Kentucky, Louisiana, Maine, Maryland, Mississippi, Nebraska, New Mexico, North Carolina, South Dakota, Utah, Virginia, Washington, West Virginia and Wyoming.

Arkansas, Montana, Nevada, North Dakota, Oregon and Texas.

California Assembly Committee on Health conducted a hearing April 16 to consider whether the emergency health powers act, Assembly Bill 1763, should be enacted. The measure as introduced has faced opposition from various community and national organizations including the ACLU and Capitol Resource Institute. Comments from the hearing states that the bill, while addressing an important subject, raises a number of issues. The subject matter of the bill is quite broad, touching on the Governor's powers to declare emergencies, the police power of state, the taking of property, the invasion of privacy, the performance of compulsory examinations, vaccinations and treatments, the rights of local health officers to isolate and quarantine individuals and groups without a court order, and granting of civil immunity from liability for negligent acts.

The opposition argues that the bill allows mandatory immunizations and quarantine without consideration for personal beliefs, when in fact the act provides for situations if any person is unable or unwilling for reasons of health, religion, or conscience to undergo vaccination to be quarantined until it has been determined that they are medically safe. All quarantine orders issued by the public health authority must still be supported by the court to be sustained.

The committee commented that existing law already provides for many of these powers granted in the act, but they are not concisely located in the text of the statutes. The suggestion was for the committee to consider if having them in one concise statute is likely to increase public and private preparedness.

Other considerations suggested by the committee broached whether:

Finally, the committee suggested consideration concerning a study and statewide hearing, comparing the provisions if the Model State Emergency Health Powers Act with current California law, and assessing the advisability of amending current law with provisions from the Model Act.

The Texas Department of Health (TDH) plans to evaluate the level of preparedness of the state hospitals to function in the event of mass casualties from a bioterrorist attack. Based on the results of the assessment, TDH leadership and the Hospital Preparedness Planning Committee will develop an implementation plan to improve the readiness of the state facilities. There are approximately 550 licensed hospitals in Texas, including acute care, military, Veteran's Affairs and psychiatric hospitals. The wide range of bed capacity and specialization suggests that there is also a wide range of levels of preparedness as well.

The assessment will compose of a collection of comprehensive information from 20 percent of the 550 plus hospitals and begin May 6, 2002 with the conclusion on August 30, 2002. The assessment tool will be developed from data sources such as the American Hospital Associations Bioterrorism Preparedness survey, the Public Health Service Office of Emergency Preparedness and the current requirements of the Joint Commission on Accreditation of Health Care Organizations (JCAHO).

Planning is the first task each state faces in redesigning public health infrastructure to prepare for prevailing threats to community health. Once a plan has been implemented, some within the community are asking, how will the public be effected and whether they will be educated concerning the best way to respond in an emergency or disaster. Concerns expressed by many reflect a community unaware of the planning activity already underway. The event of September 11, 2001 has heightened public awareness concerning threats, but has left unanswered questions as to how they can protect themselves. Health care providers are already being questioned as to the what, when, how and why, of responding to another terrorist event, natural disaster or even a nuclear incident.

Many of the proposed state bills contain provisions that outline that the public health authority will have the responsibility of organizing public information activities regarding public health emergency response operations. In an LA Times Poll conducted two months after the events of September 2001, roughly one in five Americans said they will likely be hurt or killed in a terrorist attack such as a building or plane bombing and one in four are convinced that they will be hurt or killed by an act of bioterrorism. More people are apprehensive about the usage of chemical warfare than by being killed in a building or plane bombing. (This poll was taken at the height of the anthrax scare.) The Harvard School of Public Health and Robert Wood Johnson Foundation conducted a survey in October 2001 that asked questions concerning the trust of reliable information concerning national and local outbreaks of disease caused by bioterrorism. Respondents clearly expressed that they felt the most reliable information regarding a bioterrorism event would come from their own physician, 77 percent as opposed to 48 percent for then CDC Director Jeffrey Koplan, placing great responsibility on physicians to increase their knowledge concerning disease surveillance incidents of biologic infections as result of weapons of mass destruction. However, respondents also expressed confidence in their state and local health departments. Fifty two percent of respondents said they would trust their state or local health department for accurate information in the event of a outbreak of disease as result of bioterrorism.

One of the oldest and most widely used methods of information dissemination public health and state authorities use is through the sources of voluntary participation by broadcast TV and radio, and cable providers and typically states provide a great deal of information through the Internet. State health departments are posting information slanted to the public as well as health professionals that are especially focused on bioterrorism events. State emergency planning organizations are also listing community response information, state plans and calendars of state sponsored education programs for emergency responders and the community. On-line education programs are becoming more prevalent and through the use of new technology audio conferencing has increased.

The two states most effected by the events of last September, New York and Virginia, have programs to disseminate information to protect the public health and safety. In addition to their public awareness campaign, the New York State Emergency Management Office (SEMO) developed and published a guidance document for school safety plans, Project SAVE, that can be accessed through http://www.nysemo.state.ny.us/ProjectSAVE.pdf. The New York public health department publishes a fact sheet on anthrax in English, Russian and Spanish, as many states have done in these and other languages that support the demographics of their communities. New York also opened the Public Health Council Work Group on the Public Health Infrastructure for public participation to make comment on the review of information on the public health infrastructure and to identify issues and develop a report to the Public Health Council that suggests solutions to strengthen specific aspects of the infrastructure.

As in many states, the Virginia Department of Emergency Management operates a Public Awareness Campaign through Internet information resources, safety events open to local emergency responders and other state organizations and news releases. According to the department most of the direct community education is provided through local fire departments and emergency responders. State emergency preparedness plans are available to the public through the library system and other public record access resources excluding the Terrorism Consequence Management plan, which is available only through limited distribution for security reasons. The department also sponsored the Emergency Preparedness Community Outreach Conference held in Richmond February 6, 2002. Participants at the conference were encouraged to share successful community disaster education programs or resources.

In addition to the efforts put forth by the Department of Emergency Management, the Virginia Department of Education published the Model School Crisis Plan, developed by statutory requirement enacted in 1999. The intent of the plan is to emphasize the importance of crisis management as a central component of comprehensive school safety. A comprehensive Safe Schools Plan places a strong emphasis on prevention using strategies which range from building design to discipline policies and programs which improve school climate.

The Virginia Department of Health has published a document entitled Preparing for Terrorism: A Family Guide and can be accessed at http://www.vdh.state.va.us/bt/pubinfo/guide.html, many other states have published similar guidance tools.

The Texas Department of Emergency Management has published on the web guidance for development of a family disaster plan and includes recommendations for a disaster supply kit. The information provided on the page outlines actions families should take before, during, and after a terrorist incident that were derived from the terrorism fact sheet developed by the federal Emergency Management Agency (FEMA) and may be accessed at http://www.fema.gov/library/terrorf.htm. The Texas Department of Health (TDH) is currently recruiting TDH employees who are licensed to practice mental health, nursing or medical services, infectious disease experts and epidemiologists to be responders on the TDH Hotline for Bioterrorism and Other Disasters. The hotline is expected to provide:

Training for responders is planned in September-November of 2002.

The Florida Department of Health and Human Services publishes their Emergency Operations Plan for Health and Medical Services on the web. The Community Health Resources section of the Department of Health networks with many offices within the department and other local and state agencies and organizations coordinates many programs throughout the state so that all people in Florida can receive care in their local area. The department works with communities to develop partnerships. to address health issues identified by a community and to plan and implement a locally-driven effort of concerned citizens working on common goals to improve the overall health and well-being of their community.

Healthy Communities encourages partnerships between local health departments, health care providers, businesses, community agencies, local governments and individual citizens. Community members organize projects to address priority health problems including underlying social problems that affect health, e.g., violence and crime, poverty, homelessness, and drug abuse. Health Communities create public information campaigns, health education activities, and local policies that positively influence the community as a whole. Healthy Communities uses a planning model for mobilizing community members; helping them assess the health problems and assets of a community; setting health priorities to tackle, and taking action to address identified concerns.

Holding a unique position in the Pacific Rim and having experienced a disaster as result of war, Hawaii has long had a strong civil defense and community health surveillance program. Hawaii's Threat Level Condition System served as a model for developing the new national advisory structure. The threat assessment system was developed last October in close cooperation with state agencies, Honolulu Police Department, the military, and private industry. Both the national and Hawaii systems employ color coded threat levels which can be upgraded as a threat escalates.

Hawaii State Civil Defense provides information through their web site to assist state residence in preparing for potential disasters. They take into consideration natural, technological and other forms of disasters inclusive of civil disobedience, health epidemics, terrorism, resources, infection and war. The information provided includes how to prepare for an event before it happens, what not to do during the event and what should be done during an event.

Public awareness will continue to be a priority for public health authorities across the country. Public health emergency plans must and will address renewed efforts to educate and inform the public how they can prepare for and specifically respond to various types of disasters. South Dakota is the first state this year to enact legislation, House Bill 1304, that specifically gives this responsibility to the Department of Health to organizing public information activities regarding public health emergency response operations. However, the most important guidance given by the authorities is for the public to be aware of what is going on around them and be alert.

The U.S. Department of Health and Human Services, Secretary Tommy G. Thompson, representatives of America's pharmaceutical companies and other health care officials recently announced the launch of a national educational program for health care providers to help them better identify and treat bioterrorism threats such as anthrax.

The new program, which begins as a pilot project in 13 cities, brings together health information from the U.S. Centers for Disease Control and Prevention (CDC) and the distribution resources of pharmaceutical companies. With a large sales representatives workforce across the country, the pharmaceutical industry has the ability to share important health information with doctors and other health care providers in all 50 states very quickly, said Alan F. Holmer, President of the Pharmaceutical Research and Manufacturers of America (PhRMA).

This is the kind of public-private partnership the American people need now more than ever, said Secretary Thompson. Four pharmaceutical companies -- Bayer Corporation, GlaxoSmithKline, Eli Lilly and Company, and Pharmacia Corporation -- will begin the initial roll-out by distributing 20,000 reference guides in 13 cities (Albany, Boston, Chicago, Detroit, District of Columbia, Hartford, Indianapolis, Los Angeles, Miami, Nashville, Philadelphia, Phoenix and Tampa). The initial guide outlines the three types of anthrax infections: cutaneous (skin), gastrointestinal and inhalation and discusses the symptoms and treatments for each.

The education guides being produced by PhRMA in conjunction with the CDC are designed to help health care providers answer questions posed by their patients and by others in the health care field. The guides are not intended to replace other forms of diagnosis or treatment but rather to provide health care providers with a baseline of clear, concise information that can assist them in their jobs.

Dr. Ivan Walks, director of the D.C. Department of Health, also participated in the press conference. Dr. Walks spoke of the District government's first-hand experience with a biological attack and the effects on the public's confidence. Since the first biological terror attacks, fears concerning bioterrorism pathogens have increased, said Dr. Walks. As a doctor and the chief public health official in our nation's capital, I want to ease patients' concerns, but we can only assuage their fears by providing the health care community and the lay community with up to date, reliable and accurate information. These informational guides provided by America's pharmaceutical companies will serve as a powerful reference tool and will help us to address our patients' fears in a timely manner.

A copy of the guide ('Practical Knowledge About Anthrax") as well as additional information about the pharmaceutical industry's contributions to the fight against bioterrorism can be found on HomelandHealth.com, a comprehensive web site offering current, reliable information on bioterrorism preparedness in America. HomelandHealth.com, sponsored by America's pharmaceutical companies, offers hundreds of pages of accurate, up-to-date information and news for consumers, healthcare professionals, media members and government officials.

Source: http://www.homelandhealth.com/news/media/newsreleases//2002-04-11.141.phtml

In observance of the 2002 National Public Health Week, Colorado Department of Public Health and Environment Executive Director Jane E. Norton gave a news conference April 1st. In her remarks she outline the preparatory steps the state department had made over the years since 1999 to prepare for the possibility of a bioterrorism attack. She pointed out that Colorado was the first state to enact legislation that established a framework for responding to an attack inclusive of enhancing state laboratory services and conducting training exercises for the public health workforce.

The state health director said that because of public health's involvement in preparation for responding to bioterrorism threats, the theme, Public Health Rain or Shine Preparation Protection Prevention, was chosen for the 2002 Colorado Observance of National Public Health Week.

In connection with the observance, Norton said that a brochure on Home Emergency Preparedness in Colorado has been printed by the Department of Public Health and Environment and is being distributed throughout the state. Norton said, the brochure was designed to help Coloradans better prepare for an emergency, whether it is a natural disaster, a power failure or a terrorism threat. It also contains checklists to help families assemble the items that would help them to better survive an emergency. Most of the state legislation currently in consideration holds the public health authorities responsible for dissemination of this type of information.

Dr. Ned Calonge, the acting chief medical officer and state epidemiologist who is based at the State Department of Public Health and Environment, said the department's initial work on bioterrorism preparedness began in 1999 when federal bioterrorism funds first were received from the Centers for Disease Control and Prevention.

In January, Calonge said, Colorado was designated to receive $16.3 million of the $1.1 billion in bioterrorism funds allocated by the U.S. Department of Health and Human Services and distributed by the Centers for Disease Control and Prevention. Of the $16.3 million, $14.4 million is to be used for public health bioterrorism preparedness in the state while the remaining $1.9 million is to go to the state's hospitals for work to meet the bioterrorism threat.

Bioterrorism preparations being proposed in the state under the terms of the new grant include:

Source: Health Policy Tracking Service, National Conference of State Legislatures, April 2002.