The Legal Basis and Structure of Public Health in New York State

Structure of Public Health in New York State

• State • Oversees and coordinates public health statewide • Local • Authority within geographical jurisdiction • City/town/village • County/Part-county • Consolidated 2 of 31

NYS Department of Health

Powers and Duties (PHL § 201)

• Supervise local health departments • Supervise reporting and control of disease • Supervise vital records (deaths, births and marriages) • Promote education in the prevention and control of disease 3 of 31

NYS Department of Health

Powers and duties (cont’d) • • • • • • • • • • Water supply Sewage disposal Swimming pools Ionizing radiation Bathing establishments (pools/beaches) Public Health Nuisances Public eating and drinking establishments Hotels Camps Embalming and the practice of funeral directing 4 of 31

NYS Department of Health

The Commissioner shall

“…take cognizance of the interests of health and life of the people of the State, and of all matters pertaining thereto and exercise the functions, powers and duties of the department prescribed by law” — PHL § 206(1)(a)

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NYS Department of Health

NYSDOH Commissioner has broad authority to: • Supervise all local boards of health and health officers • Investigate epidemics, cause of disease • Enforce the PHL and State Sanitary Code • Inspect State Institutions 6 of 31

Public Health Council

(PHL §220 – §229)

• • Commissioner of Health, and 14 members, appointed to 6-year terms by the Governor with the advice and consent of the Senate “

The public health council shall have power by the affirmative vote of a majority of its members to establish, and from time to time, amend and repeal sanitary regulations, to be known as the sanitary code of the state of New York, subject to approval by the commissioner

. “

— Public Health Law §225(4)

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Local Boards of Health

PHL Article 3, Title 1 ( §§ 300–312) “

There shall continue to be local boards and departments of health and health officers in the several counties, cities, villages and towns of the state except as otherwise provided by law.” — Public Health Law §300

• New York City given special status (PHL

§312)

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Local Boards of Health

• • • • • Powers (PHL § 309) Issue civil subpoenas Compel the attendance of witnesses Administer oaths and compel testimony Issue warrants Prescribe and impose penalties for the violation of, or failure to comply with, any of its orders or regulations, or any of the regulations of the State Sanitary Code 9 of 31

Local Public Health Officers

• • • • (Select) Powers and Duties (PHL § 324) Enforce the Sanitary Code Report communicable disease and births and deaths Promote the prevention of “prevalent” diseases and preservation and improvement of health Sanitary survey and supervision within geographical territory 10 of 31

County or Part-County Health Districts

• • • Created by county board of supervisors • With NYSDOH approval Includes consenting cities in county • Where not all consent, part-county districts result Local health districts continue to exist unless abolished

Article 3 Title 3 §§ 340–357

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County/Part-County Boards of Health

• Powers and Duties (PHL §§ 347–348) All powers and duties of local boards of health, PLUS • • Limited contracting authority Limited enforcement of PHL provisions related to tobacco and smoking • Adopt local rules, regulations, etc. for protection of public health in district —including a local Sanitary Code, provided it is not inconsistent with the State Sanitary Code or PHL 12 of 31

County Health Commissioner

• • Must be NYS-licensed physician Powers and Duties • • Full-time position with limited authority for other duties Supervision and control of patient treatment in facilities operate by districts • • Limited contracting authority Collection of current and overdue fees for patient treatment • Duties of local health officer 10 NYCRR §§ 11.10–11.11

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Public Health Director

• Same powers as County Health Commissioner EXCEPT • Must work in concert with a medical consultant (who must be a NYS-licensed physician) 10 NYCRR §§ 11.180–11.182

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Laws Enforced by Local Health Department/District

• Public Health Law (aspects) • State Sanitary Code • Or approved local sanitary code • Local regulations/ordinances • Any number of health-related topics, such as body-piercing parlors, local septic system inspections, etc.

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Public Health Law

(Generally)

• 50 Articles, including: • • • • • • • Article 2 Article 3 Article 13-e Tobacco Control Article 14 Regulation of Children’s Camps Article 21 Article 30 Article 41 NYSDOH Local Health Organization Communicable Disease Emergency Medical Services Vital Statistics 16 of 31

NY Codes, Rules and Regulations

(NYCRR)

• Title 10 – Health • 7 volumes 17 of 31

State Sanitary Code

(10 NYCRR Parts 1-24)

§ 225(5) The sanitary code may: (a)

deal with any matters affecting the security of life or health or the preservation and improvement of public health in the state of New York, and with any matters as to which the jurisdiction is conferred upon the public health council.

— Public Health Law §225(5)

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Sanitary Code

• • • • • • • • Statutory authority is Public Health Law § 225(5) (Selected) Prescribe the qualifications of public health personnel Regulate and promote health in Indian reservations Designate communicable diseases Regulate certain labor camps, temporary residences, and mass gatherings Regulate ionizing radiation and nonionizing electromagnetic radiation installations Facilitate epidemiological research into the prevention of environmental diseases Regulate bottled water 19 of 31

Sanitary Code

Application • Statewide • Supersedes inconsistent or less stringent local ordinances • Note: Any local sanitary code provisions must be filed with NYSDOH 20 of 31

Sanitary Code

Structure • • • • • • • Part 5 — Public Water Systems Part 6 — Swimming Pools and Bathing Beaches Part 7 — Temporary Residences, Mass Gatherings, Children’s Camps Part 8 — Public Health Nuisances Part 11 — Qualifications of Public Health Personnel Part 14 — Food Service Establishments Part 15 — Migrant Farmworker Housing

and…

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Sanitary Code

Structure • Part 16 — Ionizing Radiation • Part 17 — Mobile Home Parks • Part 40 — State Aid for Public Health Services • Part 67 — Lead Poisoning Prevention and Control • Part 74 — Approval of Realty Subdivisions • Part 75 — Standards for Individual Water Supply and Individual Sewage Treatment Systems 22 of 31

Disease Reporting

Required by Statute • PHL Art. 21 • PHL Art. 22 • PHL Art. 23 • PHL Art. 21, Title III Communicable diseases Tuberculosis STDs HIV 23 of 31

Disease Reporting

Required by Regulation (10 NYCRR) • Part 2 • Part 2.16

• Part 23 • Part 63 Communicable disease list Outbreak reporting STD control HIV reporting, testing, and confidentiality 24 of 31

Basic Reporting Authority

• • • Physicians must report diseases listed in Part 2 of the Sanitary Code to local health officers. (PHL § 2101) • Where no physician is in attendance, as a general matter the person responsible for the place the disease occurs must report NYS licensed labs must report test results and other required information (provider name, etc.) and retain records (PHL § 2102) Counties must report to State (PHL §§ 2103, 2104) 25 of 31

County Communicable Disease Control

• PHL Articles 21 and 22 • Local Board of Health • Shall guard against introduction of communicable disease through medical inspection, investigation, and control of all exposed persons and things • May provide for care when necessary for protection of public health (consult local public health service plans) • May quarantine 26 of 31

Communicable Disease

• • Health officer liability for errors in judgment in ordering quarantine is limited, unless it is unreasonable, arbitrary, malicious, or injurious due to excess of authority • See, e.g.,

Crayton v.Larabee

, 220 NYC 493 (1917) Communicable disease records are not privileged and are available to court • EXCEPT where information is made privileged as to specific diseases, such as HIV/AIDS and STDs • See, e.g.,

Thomas v. Morris

, 286 NY 266 (1941) 27 of 31

STD Control

PHL § 2300–2306 • A health officer can require a suspected STD carrier to undergo an exam and lab testing • If such person refuses, a court order may be obtained • Minors may be treated on their own consent • All reports are confidential, except limited disclosure in criminal cases and family court if patient consents 28 of 31

Other Disease Reporting Mandates

• Cancer • Provider must report to health officer where patient resides (PHL § 2401) • Reports are confidential • Disclosure for approved research permitted (10 NYCRR Part 1.31) • Tuberculosis • Provider must report to health officer (PHL §§ 2210, 2225) • Reports are confidential • Health officer has a duty to control a nuisance (PHL § 2223) 29 of 31

Military Induction Centers

• Disclosure of cancer, tuberculosis, and venereal disease information is permitted to medical examiners at induction centers (10 NYCRR Part 1.30) 30 of 31

Disease Reporting and Control

Summary of Legal Basis • Statute —PHL Articles 21, 23, 27 • Implemented in regulations • May involve judicial process • For example, orders for medical examination, quarantine, and disclosure of information • State is available to assist via program and legal consultation, as needed 31 of 31