Health Laws of Virginia - A Commissioner's Perspective

You will be taught public health law in a course by Dr. Vance.  He will provide you with the technical details of the laws that govern public health enacted at the Federal, state and local levels.  Both of us recommend that you get a copy of Larry Gostin's book 'Public Health Law'.  It is required for Dr. Vance's class.

This paper gives you an overview from the Health Commissioner's and the Local Health Director's viewpoint..

As State Health Commissioner, I could only enforce laws that came to me through the State Legislature. I had no authority to enforce health laws based on federal statutes, unless these statutes were codified into state law or adopted as part of a state law.

For example, the FDA enforces federal law regarding food safety, I could only refer violations to federal agencies if the state and localities had not encoded versions of the federal law in Virginia and community law.

State Health Code, Title 32 of the state code, which now has 8 chapters There used to be 2 more for management of Medicaid. They were removed from the health code and transferred into administration when Medicaid became a separate state agency in 1986. In addition to the Health Code there are statutes in the other titles of the state code that require action of the health department, either by direct enforcement or cooperation.

Chapter 1 - organization and administration of the department as well as the appointment of the Commissioners and members of the Board of Health, also the organization of local health departments.
Deals with the selection of the Commissioner and the structure and functions of the State Board of Health which, in Virginia, is an advisory board to the Commissioner. In Texas this is an administrative board. It selects the commissioner, with no oversight from the Governor.
What benefits or drawbacks do you believe might accompany this procedure?

Chapter 2 Focuses on disease protection and dwells on immunization standards and protection against communicable disease. Any changes to the immunization schedule have to be approved by the Board and pass through the Administrative Process, unless deemed an emergency and approved as such by the Governor.
What considerations do you think the Commissioner must consider befroe placing a disease on the list for either immunization or reporting?

Chapter 3 - Medical Care services deals not with a state medical care system, but with public health and focuses on Maternal and Child Health (including licensing of midwives). The Virginia Voluntary formulary, and the hemophilia program.
During the MCH presentation you will hear Barbara Parker discuss women's health problems and Cecelia Barbosa discuss child health. Most of the discussion is based on program content. What oversight would the Commissioner want and how would it be exercised?

Chapter 4. Health Planning, deals with the Certificate of Need Program (COPN), health planning and resources development, a State Health Coordinating Committee and regional perinatal services.
What evidence have you seen of health planning? What is COPN supposed to accomplish? How effective has health planning been in Virginia? What is the current emphasis of health planning in the State Health Department?

Chapter 5. Licensing of Medical Care Facilities focuses on hospitals, nursing homes, Home Health Agencies, hospices, EMS programs and blood bank licensing necessary for the institutions to obtain federal reimbursement.
What Federal Act prompted this oversight? Has Federal oversight improved the quality of care? How can you measure the effectiveness of this oversight?

Chapter 6.Environmental Services regulates sewage disposal, water supplies, hazardous wastes, mosquito control, migrant camps, radiation control, and toxic substances information
How is enforcement achieved for most programs? When do you resort to use of the courts?

Chapter 7 -Vital Statistics: births, deaths, adoptions, name changes, marriages.
How important is collection of these data, why is timeliness important, how can collection be improved?

Chapter 8 - Postmortem examinations and medical examiner system.
What is the difference between a Medical Examiner system and a coroner system? What are the benefits of a post-mortem examination?

In addition to responsibilities outlined in the Health Title of the state code are statutes that ensure payment to universities and colleges for training health providers.

Title 28.1 Covers responsibility for Fish, Oysters and Shellfish managed by the environmental health division.
Title 29 contains laws related to rabies control, responsibility of animal and game wardens, care of pigeons and laws barring fighting animals. If the local health director has responsibility for animal control the ruling codes are found here.
Title 35 controls campgrounds, tourist establishments, and restaurants for which the Commissioner of health promulgates standards such as those for food preparation services (which you have already heard discussed tonight.)
Title 40 Labor law involves the Health Commissioner's expertise in advice about toxic chemicals
Title 54 provides guidance the Commissioner guidance in the use of health professionals in Health Department programs.
Title 62 defines the relationships between the health department and the departments found in the secretariat of natural resources.

In addition to the above are various commissions on which the Commissioner or delegated staff members sit to give advice such as:

The Developmental Disabilities Council
The Solid Waste Commission
The Migrant Workers Commission
The Health Services Cost Review Council
The Hazardous Waste Services Act Board
The Council on the Environment
An Agency, which provides Sewer and Water, loans to localities
Soil Conservation Districts
The Virginia Water Resources Research Center at VPI
The Virginia Institute of Marine Sciences.