# Presentation: 203834

## Gene W. Matthews, J.D.
CDC Foundation

50 Hurt Plaza, Suite 765
Atlanta, GA 30303
(404) 373-1276
MatthewsPHLaw@aol.com

- Gene W. Matthews, J.D.
- CDC Foundation
**50 Hurt Plaza, Suite 765**
**Atlanta, GA 30303**
**(404) 373-1276**
**MatthewsPHLaw@aol.com**

- Institute of
- Public Health
- Law

- INSTITUTE *of** *PUBLIC HEALTH LAW

## Historical Role of Attorneys and 21st Century Public Health Practice 

- INSTITUTE *of** *PUBLIC HEALTH LAW

**ABA Center for Continuing Legal Education **
**Understanding the Role of Public Health in Your Practice **
**August 10, 2005**** **

## Historical Context

**100 years ago, lawyers were integral to the practice of public health at the community level**
**Example, Teddy Roosevelt and Long Island polio quarantine of 1890’s**
**Example, in 1905 a Chicago lawyer founded the Rotary Club: **
**	****	****--Purchased a horse for the doctor**
**	**** ****	****--Built the first public restroom****	**
**	****	****	****in Chicago**

- INSTITUTE *of** *PUBLIC HEALTH LAW

_**HISTORICAL CONTEXT**_
**1950’s : Two Ships Passed in the Night!**
- 	_**Salk Polio Vaccine**_** – 1955**
**    ****(END IN U.S. OF COMMUNITY-WIDE PUBLIC**
**        ****HEALTH CONTROL MEASURES—300 years!)**
_**Brown v. Board of Education**_** 1954**
**(BEGINNING OF MODERN EVOLUTION OF PROCEDURAL PROTECTIONS OF INDIVIDUAL LIBERTIES AGAINST GOVERNMENT ACTION)**

- INSTITUTE *of** *PUBLIC HEALTH LAW

## “A renaissance is now taking place in public health law”(...and just in time!)

- INSTITUTE *of** *PUBLIC HEALTH LAW

##     Natural Events

- 21st Century Emerging Infections
**Mad Cow Disease**
-    		**West Nile Virus**
-       		**SARS**
-         			**Monkey Pox**
-           				**Avian Flu**
-              					******Marburg Disease********??**

- Cascade of
- Communications
- Challenges

- INSTITUE *of** *PUBLIC HEALTH LAW

## Population Density

**Population Density**

- 21st Century: Travel Time vs. Population Density

**Travel Time**

- INSTITUE *of** *PUBLIC HEALTH LAW

## Human Events 

- 21st Century Asymmetrical Terrorism
**Bioterrorism Events**
-          	**Anthrax attacks of 2001**
- 		**Smallpox vaccinations of 2003**
- 		**Ricin events in 2003-2004**
**“****Conventional” Weapon Events**
- 		**Airliner hijackings of 9/11/2001**
**	****	****Madrid subway attacks of 2004**
**	****	****London transit attacks of 2005**
**Chemical & Nuclear Threats**
- 		**Chemical weapon concerns-(Sarin gas in Tokyo subway)**
**	****	****“****Suitcase bomb” & “dirty bomb” scenarios**

- Communications
- Cascade

- INSTITUE *of** *PUBLIC HEALTH LAW

## Question: “Why should I care?”

**“****In an outbreak situation, the private sector **_**cannot**_** **_**afford**_** for **_**government**_** to **_**fail**_**!”**
**Governments are facing multi-level budget deficits-federal, state, & local**
**In an outbreak, government is going to **_**need**_** the **_**help**_** of the private sector**

**Answer:**

- INSTITUTE *of** *PUBLIC HEALTH LAW

## Law/Policy Change in Public Health Emergency

- INSTITUTE *of** *PUBLIC HEALTH LAW

- THE GREEN ZONE
- “normal time”

**“****Emergency”**
- THE RED ZONE
- (Culture temporarily
- Changes)

**Immediate Aftermath**
**Moment of Law & Policy Change**

**...****and...**
**“****THE BLAME GAME”**
**may begin!**

**(Selective Amnesia Returns)**

## 		30,000 “voluntary” quarantines over 3 months  			      27 formal quarantine orders...and..   	          			1 appeal (withdrawn)   MORE SOCIAL          	 COHESIONToronto experienced a temporary shift increasing social cohesionCompliance with quarantine directives was substantial		One example of how a culture temporarily changes       		

- 		**30,000 “voluntary” quarantines over 3 months **** ****	****	****	****      27 formal quarantine orders...and..   ****	****          ****	****	****	****1 appeal (withdrawn)****   **_**MORE**_** SOCIAL****          ****	**** COHESION****Toronto experienced a temporary shift **_**increasing social cohesion**_**Compliance with quarantine directives was substantial****	****	****One example of how a culture temporarily changes   ****    ****	****	**

- The Toronto Example of the RED ZONE—2003 SARS

_**NOT**_** DIVISIVENESS**
**& PANIC**

- INSTITUTE *of** *PUBLIC HEALTH LAW

## A “Tipping Point” for SARS Leadership in Toronto

**On the day that the large medical**
**convention cancelled in Toronto,**
**the **_**center**_** of leadership **_**shifted**_**:**
**                                            **
**A **_**Health**_** Problem for               An **_**Economic**_** Problem**
_**Government**_** Leaders                 for **_**Business**_** Leaders**
**To Solve****	****	****	****	****       To Solve****	**

- INSTITUTE *of** *PUBLIC HEALTH LAW

- BECAME

## Initial Lessons

**Lessons from Toronto are readily **_**understandable**_** and are **_**transferable**_** to other settings.**
_**The Biggest Lesson**_**: The “Balance of Governance” **_**is significantly (if only temporarily) altered**_** during an emergency.**
- _Business_** and **_**Public Health**_** need to build **_**bridges**_** with each other **_**before**_** a crisis.**** **

- INSTITUTE *of** *PUBLIC HEALTH LAW

## The Green Zone: Normal Times

- INSTITUTE *of** *PUBLIC HEALTH LAW

- Normally, there is distance between these entities
- because of different goals, agendas, & strategies

## The RED ZONE: An Emergency

- INSTITUTE *of** *PUBLIC HEALTH LAW

- Relationships are altered during an
- emergency—we need to _plan_ for it..._now_.

- Persons are more likely to
- follow quarantine orders

- Employees get their information
- through their employers

- Businesses engage & lead
- in economic recovery plans

## An Example of One Window of Change:Rapid National Legal/Policy Changes That Followed 9/11/01

**Department of Homeland Security created**
**BT Infrastructure Block Grants to states**
**USA PATRIOT Act Enacted**
**Select Agent Rule for control of BT pathogens**
**Model State Emergency Health Powers Act Drafted**
**Airline Recovery Legislation Enacted**

- INSTITUTE *of** *PUBLIC HEALTH LAW

## Law/Policy Change in Public Health Emergency

- INSTITUTE *of** *PUBLIC HEALTH LAW

- THE GREEN ZONE
- “normal time”

**“****Emergency”**
- THE RED ZONE
- (Culture temporarily
- Changes)

**Immediate Aftermath**
**Moment of Law & Policy Change**

**...****and...**
**“****THE BLAME GAME”**
**may begin!**

**(Selective Amnesia Returns)**

## What can we do to plan for moments of legal and policy change?

**Start linking businesses, governments, & civic leaders about this agenda**
**Use civic groups, trade associations, academic centers & preparedness forums to address these obvious issues. **
_**Examine**_** **_**legal**_** **_**concerns**_**: sick leave policies, liability limitation, compensation, insurance coverages, Good Samaritan Laws, etc.**
**Recognize that the ****“normal”****, risk-averse decision-making does not always work in the **_**Red Zone**_

- INSTITUTE *of** *PUBLIC HEALTH LAW

## Rediscover leadership role of community lawyers in public health

Remember the model of 100 years ago
Lawyers are also interested in community public health issues beyond emergency preparedness
Policy reform is instinctive to lawyers

**Remember the model of 100 years ago**
**Lawyers are also interested in community public health issues beyond emergency preparedness**
**Policy reform is instinctive to lawyers**

- A Reminder for the 21st Century

- INSTITUTE *of** *PUBLIC HEALTH LAW

## Gene W. Matthews, J.D.
CDC Foundation

50 Hurt Plaza, Suite 765
Atlanta, GA 30303
(404) 373-1276
MatthewsPHLaw@aol.com

- Gene W. Matthews, J.D.
- CDC Foundation
**50 Hurt Plaza, Suite 765**
**Atlanta, GA 30303**
**(404) 373-1276**
**MatthewsPHLaw@aol.com**

- Institute of
- Public Health
- Law

- INSTITUTE *of** *PUBLIC HEALTH LAW

*"The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.” *