1 VHP Legal and Regulatory Issues in Real-time during the Gulf Coast Hurricane Emergencies James G....

1

VHP Legal and Regulatory Issues in Real-time during the

Gulf Coast Hurricane EmergenciesJames G. Hodge, Jr., J.D., LL.M. Lance A. Gable, J.D., M.P.H.Principal Investigator, HRSA ESAR-VHP Legal Project Director, HRSA ESAR-VHP Legal and Regulatory Issues Project and Regulatory Issues ProjectAssociate Professor, Johns Hopkins Bloomberg School of PHExecutive Director, Center for Law & the Public’s Senior Fellow, Center for Law & the Public’sHealth at Georgetown and Johns Hopkins Health at Georgetown and Johns Hopkins Universities Universities

The Center for Law & the Public’s Healthat Georgetown& Johns Hopkins Universities

CDC Collaborating Center Promoting Health through LawWHO/PAHO Collaborating Center on Public Health Law and Human Rights







2

Principal Objectives

Assessing the Legal Environment During Emergencies

The Center’s Real-time Responses to Hurricanes Katrina, Rita, and Wilma

Specific Issues for Workshop Discussion

Legal authority to deploy VHPs Multiple levels of emergency declarations EMAC limitations “Federalizing” VHPs

Questions, Comments, Thought for Discussion





3

Assessing the Legal Environment in Emergencies





Community

City

County Tribal

State

National

International

Govern-ment

4






Compacts

Cases

Policies Regulations

Statutes

Constitutions

Treaties

Types of Laws

5






Emergency Management

Private Industries

NGOs

Hospitals

National Security

Law Enforcement

Environment

Public Health

Partners

6






Military

Volunteers

HealthAdministrators

Health CareWorkers

Federal Agents

Police Officers

Lab Directors

Public HealthOfficials

Actors

7






Government

PartnersActors

Emergency-based Legal Triage

8

Assessing the Legal Environment – Hurricane Katrina





• Invocation of Federal and State Emergency Declarations

• Interjurisdictional Coordination Among Federal, State, and Local Governments

• Capacity to Utilize Volunteer Health Personnel and Others

• Actual and Anticipated Harms to Displaced Persons and Those Assisting Them

• Potential for Litigation & Policy Reform

9

Assessing the Legal Environment in Disasters – Hurricane Katrina





Emergencies

Licensing

Liability Protections from Harms

10

Center’s Real-Time Responses to Legal Issues During the Hurricane-related Emergencies

• Extensive consultation with VHPs en route and on location in AL, LA, MS, TX, and other states

• Additional consultation with prospective senders and hosts of VHPs

• Production of memos and articles re: specific legal issues• Tracking of federal and state legal responses• Circulation of new editions of HRSA’s

Legal and Regulatory Issues Report (9/05) and the Center’s Advanced Tool Kit (8/05)

• Resources available at www.publichealthlaw.net/ Research/Affprojects.htm





11

Specific Issues for Workshop Discussion

Legal Authority to Deploy VHPs

Multiple Levels of Emergency Declarations

EMAC Limitations Concerning Private Sector VHPs

“Federalizing” VHPs through DHHS





12






1 9 4

2 9 5 8

9 2

4 8 5 6

6 2 7 4 3 1

8 2 6 9

6 9

8 5 4 3

7 5 9

The

VHP

SU

DO

KU

13






1 9 8 4

2 9 6 5 8

9 2

4 8 5 6 2

6 2 7 4 3 1

5 8 2 6 9

6 7

8 5 4 3

7 5 9

Question?

How Are These VHP Gaps Filled?

14






1 L S 9 F P 4

2 9 P L 5 8

9 2 P L

S 4 8 5 6 F

6 2 7 4 3 1

F 8 2 6 9 S

P L 6 7 S P

8 5 4 3

7 P S 5 L S 9

Question?

Who Fills the Gaps?Feds [F], States [S], Locals [L], Private Sector [P]

15






• Federal agents• DHHS’ or other full-time employees• Federalized agents• Military personnel

• State or local agents• State or local full-time employees via EMAC• Temporary state agents

• National Guard, Medical Reserve Corps

• Private Sector• Hospitals or other care providers• Charitable organizations

• ESAR-VHP

16


• Federal, state, and many local governments have the ability to declare a state of “general emergency” or “disaster.” The powers and processes that arise from such declarations vary.

• Federal and many state governments (as well as some locals) may also declare “public health emergencies.”

• Emergency powers, legal protections, and operational definitions may be inconsistent in “dual declaration” states.





17

Emergency Declarations

Once an emergency has

been declared, the legal

landscape changes.





18

Emergency Declarations

Government is vested with specific powers to facilitate emergency responses

Individuals are bestowed special protections

State licensure requirements may be waived

Responders may be protected from civil liability





19






Local emergency or disaster

Local public health emergency

State emergency or disaster

State public health emergency

Federal “FEMA” emergency

Federal “DHHS” public health emergency

VHP deployment, uses, authorities, liabilities, immunities, protections from harm vary (and those with

the answers) depend on the declared emergency

20






Local emergency or disaster

Local public health emergency

State emergency or disaster

State public health emergency

Federal “FEMA” emergency

Federal “HHS” public health emergency

21

EMAC: Volunteer Health Professionals

• Emergency Management Assistance Compact (EMAC)

Mutual Aid Agreement Passed into law by 49 states Formalized emergency request framework Broad immunity for responders –

considered agents of requesting state





22

EMAC Limitations Concerning Private Sector VHPs: Filling the Pool





State Officers and Employees

Private SectorLocal Employees

23

EMAC: Volunteer Health Professionals

• How EMAC is designed to work:

Pool of responders are needed to fill surge capacity needs

These needs are only partially filled using the available VHPs who are “state officers or employees”





24

EMAC Response: Hurricane Katrina

• State approaches to fill the pool:

Memoranda of Understanding with local governments or private volunteers (OH)

Temporary hiring or appointment to state positions (MD)

Automatic incorporation of local government employees into the state government (VA)





25

EMAC Responses in Future Emergencies

• Potential state approaches to fill the pool:

Expansion of temporary hiring procedures under state laws to systematize these processes

Amendment of EMAC to include coverage for a broader array of VHPs





26

EMAC Responses in Future Emergencies

• Limitations on future efforts to fill the pool:

Existing EMAC structure may deter some potential volunteers

Sending states may not wish to take on the burdens of taking on extra responders

Amendment of EMAC legislation may be politically challenging





27

Federalization of VHPs: Opening the Door

The federal government has authority to “federalize” VHPs during a declared general or public health emergency





Federal Government

28


Three approaches may be used under federal law to incorporate volunteers: Intermittent disaster

response personnel Temporary HHS

volunteers Schedule A of the

Excepted ServiceThe Center for Law & the Public’s Health

at Georgetown& Johns Hopkins UniversitiesCDC Collaborating Center Promoting Health through Law

WHO/PAHO Collaborating Center on Public Health Law and Human Rights



Federal Government

29


Federalized VHPs qualify for a variety of legal protections for the duration of their participation in the emergency response





Legal Protections:

Immunity from Civil Liability (FTCA)

Workers’ Compensation Coverage (FECA)

Reemployment Rights

30

Federalizing VHPs: Issues

When may states use federal volunteers?

Who is in control of federal VHPs? How do federal VHPs, EMAC VHPs, and

state, local, and private sector health professionals work together?

Who is in charge?





31

Questions, Comments, Thoughts

• Opportunity for Discussion

• For more information, contact us or visit our website:

www.publichealthlaw.net/Research/Affprojects.htm

• James G. Hodge, Jr., Executive Director [email protected]

• Lance Gable, Senior Fellow [email protected]





1 VHP Legal and Regulatory Issues in Real-time during the Gulf Coast Hurricane Emergencies James G....

Documents

Transcript of 1 VHP Legal and Regulatory Issues in Real-time during the Gulf Coast Hurricane Emergencies James G....