Health Policy Tracking Service

As of April 8, 41 states and the District of Columbia are in regular session. These states are Alabama, Alaska, Arkansas, Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York, Nevada, North Dakota, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Vermont, Washington and Wisconsin.

Kentucky, Maryland, Mississippi, New Mexico, South Dakota, Utah, Virginia, West Virginia and Wyoming.

The CDC is recommending that people with heart disease not get vaccinated against smallpox as the investigation into a possible link between the vaccine and heart problems continues.

The CDC said that as of March 28, seven cases of adverse cardiac events have been reported in civilian health care workers and 10 cases of myopericarditis have been reported among military vaccinees. Two civilian health care workers and a member of the National Guard died after suffering from myocardial infarction. Health officials said they do not know if the vaccine played a part in the deaths or the other cases, but that the issue should be studied further.

The CDC's Advisory Committee on Immunization Practices has recommended that the list of people who should not receive the smallpox vaccine be expanded to include individuals with three of more of the following major risk factors for heart disease: smoking, diabetes, high blood pressure and high cholesterol.

California, Illinois and New York have temporarily suspended their smallpox vaccination programs while the link between the vaccine and heart problems is investigated. Florida and several other states have postponed vaccinations until their state public health officials can update potential volunteers on new safety measures concerning heart problems.

Researchers at the Agency for Healthcare Research and Quality will soon begin a three-month pilot project that will use instant messaging technology to send urgent messages about bioterrorist attacks to more than 700,000 health care workers, including 250,000 physicians. The project will use a private handheld computer network called ePocrates to send messages containing an alert about six diseases or biological agents considered high threats: anthrax, botulism, plague, smallpox, tularemia and viral hemorrhagic fevers. In addition, the messages will contain Web links for more information about a topic. The new system would supplement the existing Health Alert Network, through which the Centers for Disease Control and Prevention sends out bulletins to more than 25,000 public health officials nationwide. In 2001, HHS used teleconferences and the Internet to communicate messages about the anthrax attacks to health workers, but many doctors said the method was too slow and cumbersome.

The General Accounting Office found that cities and states have large differences in their readiness for a bioterrorist attack and seek federal guidelines on steps that they should take to prepare. The report, which studied seven unnamed states and seven unnamed cities, found that most have plans to address natural disasters but not plans to address a bioterrorist attack. However, the report said that cities with more experience in public health emergencies and special events were more prepared to address a bioterrorist attack than cities with less experience. The report recommended that cities and states improve their communication, coordination and ability to detect diseases that could result from a bioterrorist attack. The cities studied criticized the lack of federal guidelines to help them prepare for a bioterrorist attack; the report recommended that HHS and the Department of Homeland Security develop guidelines that define adequate preparedness for a bioterrorist attack. Sen. Edward Kennedy (D-Mass.) said that the report indicates that cities and states nationwide lack adequate preparedness for a bioterrorist attack. He said, "The nation's health departments and hospitals urgently need new resources to protect America against biological attacks."

President Bush issued an executive order adding severe acute respiratory syndrome, or SARS, to the list of illnesses for which the government can order someone held to prevent contagion. This gives federal health officials standby power to quarantine anyone suspected of being infected with the new, sometimes fatal lung disease that is spreading around the world. It is the first time in 20 years that the list of diseases subject to federal quarantine has been expanded. In 1983, the disease caused by the deadly Ebola virus was added. The last time anyone was detained in a federal quarantine was in 1963, to prevent the spread of smallpox. Federal health officials have said repeatedly that they have no plans to quarantine anyone and that the move was just a precaution. Worldwide, SARS is believed to have struck at least 2,353 people in 18 nations. At least 84 have died. Most of the cases have occurred among people who recently returned from parts of Asia where the disease is most common. Travelers have infected four family members and two health care workers upon their return. No one has died, and for unknown reasons the disease appears so far to be less severe in the United States.

Wyoming lawmakers approved Senate Bill 11, which contained provisions that provide an individual subject to a quarantine order the right to appeal in court. The law places the burden of proof on the state authorities, except in a situation of medical uncertainty. Other provisions prohibit the administration of treatment without an individuals consent. However, during a public health emergency, the State Health Officer may subject a person to vaccination or medical treatment without consent in the following circumstances:

Legislators in New Mexico approved House Bill 231, which contains provisions to amend the state quarantine procedures. The measure requires individuals subject to a quarantine order will be allowed to contest the order in court with the burden of proof resting on the health officer issuing the order. The measure also outlines the terms and conditions that must be in place before isolating or quarantining a person and requirements for proper notification. The Secretary of Health is granted authority to temporarily quarantine an individual before obtaining a court order if the individual is felt to pose a threat to the community. The secretary also is given the authority to quarantine an individual who refuses to submit to medical examination or testing if they have been exposed to a person infected with a threatening communicable disease. Other provisions in the act grant authorities to the Secretary of Health to order vaccinations, secure or evacuate health facilities, control or restrict the sale of health care supplies and oversight of the safe disposal of human remains.

Idaho lawmakers passed Senate Bill 1075, which defined isolation and quarantine. This act states that the Director of Department of Public Health will have the power to impose and enforce orders of isolation and quarantine to protect the public from the spread of infectious or communicable diseases or from contamination from chemical or biological agents, whether naturally occurring or propagated by criminal or terrorist act. If the director has reasonable cause to believe a chemical or biological agent has been released in an identifiable place, including a building or structure, an order of quarantine may be imposed to prevent the movement of persons into or out of that place, for a limited period of time, for the purpose of determining whether a person or persons at that place have been contaminated with a chemical or biological agent which may create a substantial and immediate danger to the public. Any person who violates an order of isolation or quarantine will be guilty of a misdemeanor.

Virginia House Bill 2816 grants authority to the Department of Emergency Management to coordinate with political subdivisions and state agencies concerning emergency preparedness plans and to conduct statewide emergency management assessments. The measure also requires the department to encourage private industries whose goods and services are deemed vital to the public good to annually provide updated preparedness assessments to the local coordinator of emergency management.

VIRGINIA LEGISLATURE PASSES BILL CONCERNING THE DISSEMINATION OF INFORMATION

Governor Warner signed Virginia House Bill 2182, which authorizes the Department of Health to require certain licensed, certified or registered persons to report any email address, telephone number and facsimile number that may be used to contact the person in the event of a public health emergency. The email addresses, telephone numbers and facsimile numbers will not be published, released or made available for any other purpose. The director, in consultation with the Department of Health and the Department of Emergency Management, will adopt regulations that identify those licensed, certified or registered persons who will be required to report and the procedures for reporting.

Oklahoma senators narrowly rejected House Bill 1467, concerning catastrophic health emergencies, such as terrorist attacks. The bill would have created a task force consisting of individuals from the medical community. The task forced was charged with coordinating services of physicians, nurses, laboratory technicians and mental health support. The governor could also declare a catastrophic health emergency.

Rhode Island will use $9.7 million of federal money to improve its ability to detect and deal with bioterror and chemical warfare attacks and strengthen its public health system. The money will be use towards staffing, training, laboratory, computer and communications equipment. The improvements will help with the detecting, reporting and controlling of diseases. The Health Alert Network will be able to work 24 hours a day and will link local health agencies with the state department and national institutions. Improvements with communicating with the public will be made as well.

Legislators in Utah passed House Bill 160, which contains provisions that would suspend normal licensure requirements for health care professionals during a declared state of emergency. As many states face the challenge of declining numbers of various health disciplines, they have been forced to consider what would happen during a period of dire need. The provisions in this act would allow health practitioners licensed in another state and in good standing to function in Utah as they would in their home state without going through the usual procedures. The health professionals addressed in this act include physicians, nurses, certified nurse midwives, pharmacists, pharmacy technicians and pharmacy interns, respiratory therapists, dentists and dental hygienists. Other provisions in the act grants immunity from civil liability during a state of emergency to those assisting governmental agencies.

The Virginia Legislature approved House Bill 2183, which provides that the Commissioner may authorize persons who are not authorized by law to administer or dispense drugs or devices to administer or dispense all necessary drugs or devices in accordance with protocols established by the Commissioner when:

The Commissioner will develop protocols, in consultation with the Department of Health Professions, that address the required training of such persons and procedures for such persons to use in administering or dispensing drugs or devices.

In the midst of states initiating smallpox vaccination programs for the first time in 33 years, many questions remain concerning the potential for significant harm due to side effects of the vaccine. Lawmakers have been encouraged to consider the disposition of liability would pose on health facilities and persons providing the immunizations. Virginia Governor Warner signed Senate Bill 897, which provides immunity for a hospital's health care workers, including independent contractors, persons with practice privileges, individuals who have agreed to be on-call in the hospital's emergency room and individuals who routinely provide prehospital care to patients admitted to the facility.