This is a presentation of research written by Kate Whelley-McCabe, Soraya Ghebleh, Caitlin Stanton, and AJ Von-Tassel, that looks at how to improve the public's health despite constitutional impediments.
Improving the Public Health Despite Constitutional Impediments How State A=orneys General Can and Do Effect Legally Sustainable Change in Public Health Policy June, 2013 Kate Whelley McCabe Assistant A3orney General Office of the Vermont A3orney General Caitlin Stanton Vermont Law School JD Expected May, 2014 Soraya Ghebleh Geisel School of Medicine, The Dartmouth Institute MPH, June 2013 AJ VanTassel Investigator Office of the Vermont A=orney General
Transcript
Improving the Public Health Despite Constitutional Impediments
How State A=orneys General Can and Do Effect Legally Sustainable Change in Public Health Policy
June, 2013
Kate Whelley McCabe Assistant A3orney General
Office of the Vermont A3orney General
Caitlin Stanton Vermont Law School JD Expected May, 2014
Soraya Ghebleh
Geisel School of Medicine, The Dartmouth Institute MPH, June 2013
AJ Van-‐‑Tassel Investigator
Office of the Vermont A=orney General
Table of Contents
Obesity Gun Violence
End-‐‑of-‐‑Life Care Infectious Disease
Prescription Drug Abuse Environmental Toxins
Food Safety Mental Health
Injury Hospital Price Se?ing
Made Possible by the Generosity of the Robert Wood Johnson Foundation and the National Association of A3orneys General
Obesity
Scope -‐‑ 33% of adults are overweight -‐‑ 1 in 3 children are overweight -‐‑ Cost estimated to be over $100 billion dollars annually
Causes -‐‑ Improper diet, lack of physical activity -‐‑ Socioeconomic factors -‐‑ Poor nutrition, limited access to healthy foods
2010: Vermont A6orney General Convenes Stakeholders, Invites Legislature to Combat Obesity
“With current trends, our kids’ generation will be less healthy than our own. Shame on us, if we let this happen.” –AG Sorrell
Coast is Clear -‐‑ Regulate foods available in public schools
Navigation Required -‐‑ Restrict marketing to children -‐‑ 1st Amendment -‐‑ Dormant Commerce Clause -‐‑ NLEA Preemption
Gun Violence
Scope -‐‑ 30,000 deaths and 300,000 injuries annually
-‐‑ Cost burden estimates range from $10 billion to $100 billion
-‐‑ Crimes with guns are 44x more likely to be fatal
Causes -‐‑ Gun ownership coupled with certain educational, behavioral, and socioeconomic factors
-‐‑ Substance abuse and crime -‐‑ Mental health coupled with other factors
2013: New Jersey A6orney General Uses Criminal Forfeiture Monies To
Buy Back Guns
“To date approximately 5,000 guns . . . have been taken out of circulation as a result of these buybacks. . . . We recognize that these buybacks aren’t a singular, one-‐‑stop solution to the gun violence problem. However, they are important because, as we all recognize, there are just too many firearms circulating out there and too many innocent people dying or being critically wounded as a result.” –AG Chiesa
Coast is Clear
-‐‑ Planning for crises -‐‑ Reduce circulation
Navigation Required
-‐‑ Nearly everything else -‐‑ 2nd Amendment
End-‐‑of-‐‑Life Care
Scope -‐‑ 10-‐‑12% of overall healthcare spending (30 billion) on end-‐‑of-‐‑life care per year
-‐‑ 80% of deaths occur in hospital
Nature of Problem -‐‑ Patient involvement in choices limited -‐‑ Mechanisms through which choices made inadequate
-‐‑ Expense -‐‑ Quality of care
2006: Montana A6orney General Coordinates The Montana End-‐‑Of-‐‑
Life Registry
“Decisions about end-‐‑of-‐‑life medical care are deeply personal, and it’s important that they are made and documented well in advance of a terminal illness or medical emergency. . . . The registry is an extremely effective way to ensure that your wishes are known and respected.” –AG McGrath
Coast is Clear
-‐‑ Improve documentation of choices -‐‑ Establish compassionate care benefit -‐‑ Improve provider curriculum
Scope -‐‑ Universal -‐‑ CDC estimates 21,000 new cases of Hep. A, 2.5 -‐‑ 4 million Hep. C, and over 1 million new STDs annually
-‐‑ HIV/AIDS, lyme disease, pneumonia, influenza all have high cost burden
Causes -‐‑ Host of factors varying in appearance, prevalence, transmission, and severity
2012-‐‑2013: Michigan A6orney General Takes Administrative Legal Actions Against Compound Pharmacy
“Michigan citizens demand that drug manufacturers follow the laws designed to keep consumers safe. In this case, mistakes resulted in tragedy for Michigan families. We will take every step necessary to restore public safety and welfare.” –AG Schue=e
Coast is Clear
-‐‑ Reduce drug resistance -‐‑ Encourage vaccination
Navigation Required
-‐‑ Mandate vaccinations, testing, quarantine
-‐‑ 4th Amendment -‐‑ Equal Protection -‐‑ Due Process
Prescription Drug Abuse
Scope -‐‑ Approximately 19 million Americans currently abuse Rx Drugs
-‐‑ Estimated 6,600 new abusers daily Causes -‐‑ Incorrect prescribing practices, aggressive marketing strategies, drug diversion
-‐‑ Introduction of highly addictive drugs, increase in drug availability
2011-‐‑2013: Florida A6orney General Asks Legislature, Task Force, Feds to Join Her Fight Against Prescription
Drug Abuse “Our state needs a unified effort at every level. . . . We are working with state and local law enforcement, as well as our federal partners, to curtail the dangerous dispensing and abuse of prescription drugs.” – AG Bondi
Coast is Clear
-‐‑ Establish limits on prescribers -‐‑ Reduce illicit access -‐‑ Improve treatment for addiction
Navigation Required
-‐‑ Mandatory employee drug testing -‐‑ 4th Amendment
Environmental Toxins
Scope -‐‑ 25% of diseases worldwide are a3ributed to environmental factors
-‐‑ Cost burden of over $54 billion dollars annually
2013: New Mexico A6orney General Uses Bully Pulpit To Fight Copper
Mine Rule “The environment is not Democrat or Republican. The environment is for us all. My office will fight for the present and future generations of New Mexicans to protect our water resources.” –AG King
Food Safety
Scope -‐‑ 1 in 6 Americans get sick from contaminated food
-‐‑ Estimated cost burden of over $77.7 billion each year
2012: New York A6orney General Enforces Criminal Laws To Ensure
Food Safety “We will continue to pursue cases where individuals advance their own greed above the law and the health of the public.” –AG Schneiderman
Mental Health
Scope -‐‑ Only 17% of adults in the US are at “optimal mental health”
-‐‑ Estimated annual cost burden of $57.5 billion
Causes: -‐‑ Fragmented care -‐‑ Limited access to services -‐‑ Stigma associated with mental illness
2011: Rhode Island A6orney General Uses Courts To Bring Mental Health
Services To Veterans “Each year, hundreds of Rhode Islanders serve in our nation’s military in combat zones. Post-‐‑traumatic stress disorder is a real issue for veterans. For many, the transition back to home is difficult and can result in bad choices that put them in conflict with the law. It is incumbent upon us to provide a legal system that does not penalize our veterans, but rather provides access to treatment necessary to transition back to their families, their jobs, and their community.” – AG Kilmartin
Injury
Scope -‐‑ Cost burden of more than $465 billion annually
-‐‑ 180,000+ deaths occur from injury every year
Causes -‐‑ Traumatic Brain Injury (TBI) -‐‑ Falls and accidents -‐‑ Motor vehicle accidents -‐‑ Sports-‐‑related injury -‐‑ Work-‐‑related injury
2012: Kansas A6orney General Takes Position That Doctor Must Clear
Student Athletes For Post-‐‑Concussive Play
“Although the legislative history of the School Sports Head Injury Prevention Act is ambiguous,” its text is clear. Given [its] plain language, we opine that the examination and clearance required by the Act must be provided by a . . . person licensed to practice medicine and surgery, not a person delegated by such a heath care provider.” -‐‑AG Schmidt
Hospital Price Se?ing
Scope -‐‑ Extreme variations in prices with widespread lack of transparency
-‐‑ Variations estimated to cost $36 billion annually in wasted resources
Causes -‐‑ No requirement to share hospital prices
-‐‑ Variations in prices on identical procedures
-‐‑ Lack of consensus on actual cost of different procedures
2011: Massachuse6s A6orney General Continues Fight Against Rising
Health Care Costs “The continued increase in health care costs is one of the most important issues confronting families and businesses. Our investigation shows that a move to global payments is not the panacea to controlling costs without first addressing provider price disparities that are not related to the quality or complexity of the services being provided.” -‐‑ AG Coakley
Contact Information
Kate Whelley McCabe Assistant A=orney General Public Protection Division
Vermont Office of the A=orney General 109 State Street
