Health Authority and the County

Health Authority and the County

Health Authority and the County V.G. Young School for County Commissioners Courts February 21, 2019 Todays Topics Historical Background Public Health Statutory Framework Health Authority Q&A Legal Protections Case Study 2/21/2019

V.G. Young School for County Commissioners Courts 2 Historical Background Commissioners court shall exercise powers and jurisdiction over all county business Texas Constitution of 1876, Art. V, 18(b) as amended 2/21/2019 V.G. Young School for County Commissioners Courts 3

Historical Background 1891: county judge empowered by Legislature to appoint a part-time county physician to make and enforce local quarantine regulations Dick Smith, "COUNTY HEALTH AUTHORITY," Handbook of Texas Online, Texas State Historical Association 2/21/2019 V.G. Young School for County Commissioners Courts 4 Historical Background

1909: office of county physician abolished and position of county health officer established; charged with giving medical care to people in jails and poorhouses and to those on the pauper rolls of the county Dick Smith, "COUNTY HEALTH AUTHORITY," Handbook of Texas Online, Texas State Historical Association 2/21/2019 V.G. Young School for County Commissioners Courts 5 Historical Background

1983: Local Public Health Reorganization Act combines prior legislative authority for consistency; health officer becomes health authority 190 1 2/21/2019 Acts 1983, 68th Leg. ch. V.G. Young School for County Commissioners Courts 6 Historical Background

1989: Local Public Health Reorganization Act recodified as chapter 121, Health & Safety Code 678 1 2/21/2019 Acts 1989, 71st Leg. ch. V.G. Young School for County Commissioners Courts 7 Public Health public health n the art and science dealing with the protection and improvement of

community health by organized community effort and including preventive medicine and sanitary and social science - Merriam-Websters Collegiate Dictionary (11th Ed. 2004) 2/21/2019 V.G. Young School for County Commissioners Courts 8 Public Health health n 1 a: the condition of being sound in body, mind, or spirit; esp: freedom from physical disease or pain b: the general

condition of the body - Merriam-Websters Collegiate Dictionary (11th Ed. 2004) 2/21/2019 V.G. Young School for County Commissioners Courts 9 Public Health Individual One Narrow concerns Anecdote Society Many Broad concerns

Data 2/21/2019 V.G. Young School for County Commissioners Courts 10 Public Health Medical Care Focuses on individual Vital to some at some times Saves lives one at a time Treats the condition

2/21/2019 V.G. Young School for County Commissioners Courts 11 Public Health Public Health Focuses on society Vital to all at all times Saves lives all at once Prevents, protects, and promotes 2/21/2019

V.G. Young School for County Commissioners Courts 12 20 Century Life Expectancy th 80 Increase due to medical care advances: 5 years Increase due to public health measures: 25 years

60 40 20 0 1900 2000 Ten Great Public Health Achievements -- United States, 1900-1999 MMWR, April 02, 1999/48(12); 241-243 http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm 2/21/2019

V.G. Young School for County Commissioners Courts 13 Statutory Framework Texas Constitution, Art. V, 18(b) Authorizes commissioners court to exercise such powers and jurisdiction over all county business, as is conferred by this Constitution and the laws of the State 2/21/2019 V.G. Young School for County Commissioners Courts

14 Statutory Framework TEXAS HEALTH & SAFETY CODE Chapter 122 Authorizes commissioners court to appropriate and spend money from the county general revenues for public health and sanitation in the county 2/21/2019 V.G. Young School for County Commissioners Courts

15 Statutory Framework TEXAS HEALTH & SAFETY CODE Chapter 121 (Local Public Health Reorganization Act) Authorizes commissioners court to enforce any law that is reasonably necessary to protect the public health 2/21/2019 V.G. Young School for County Commissioners Courts

16 Statutory Framework TEXAS HEALTH & SAFETY CODE Chapter 121 (Local Public Health Reorganization Act) Describes qualifications and duties of a health authority 2/21/2019 V.G. Young School for County Commissioners Courts 17

Statutory Framework 25 TEXAS ADMIN. CODE 85.1 Sets out rules for health authority 2/21/2019 V.G. Young School for County Commissioners Courts 18 Health Authority Physician* appointed under the Local Public Health Reorganization Act to administer state & local laws relating to public health within the appointing bodys jurisdiction

HSC 121.021 *physician: person licensed to practice by Tex. Med. Board HSC 121.002(2) 2/21/2019 V.G. Young School for County Commissioners Courts 19 Health Authority Qualifications Competent physician with a reputable professional standing Legally qualified to practice medicine in Texas

Resident of Texas Takes official oath Files copy of oath & appt. with DSHS HSC 121.022 2/21/2019 V.G. Young School for County Commissioners Courts 20 Health Authority Term of office Two years May be reappointed to successive terms

121.023 2/21/2019 HSC V.G. Young School for County Commissioners Courts 21 Health Authority Removal For cause Use countys personnel procedures applicable to department heads 121.025

2/21/2019 HSC V.G. Young School for County Commissioners Courts 22 Health Authority Vacancy If a health authority leaves for any reason, immediately notify DSHS and regional director Notify regional office once new health authority is appointed

85.1(i) 2/21/2019 25 TAC V.G. Young School for County Commissioners Courts 23 Health Authority A health authority is a state officer when performing duties prescribed by state law. 121.024(a)

2/21/2019 HSC V.G. Young School for County Commissioners Courts 24 Health Authority Duties include those necessary to enforce a law to protect public health those prescribed by DSHS 121.024(b) 2/21/2019

HSC V.G. Young School for County Commissioners Courts 25 Health Authority Duties include quarantine aid DSHS in public health efforts disease prevention & suppression birth & death statistics general sanitation 121.024(c)

2/21/2019 HSC V.G. Young School for County Commissioners Courts 26 Health Authority Duties include reporting diseases, etc. aid DSHS in enforcement rules, ordinances, etc. sanitation laws quarantine rules vital statistics collection

121.024(c) 2/21/2019 HSC V.G. Young School for County Commissioners Courts 27 Health Authority Examples Court-ordered control measure for person with communicable disease Review application for mass gathering permit Disaster planning & response

Education & outreach Sanitation/code enforcement 2/21/2019 V.G. Young School for County Commissioners Courts 28 HA Q & A When can my county directly appoint a health authority? If it has not established a health department or public health district HSC 121.028(a)

2/21/2019 V.G. Young School for County Commissioners Courts 29 HA Q & A Does my county have to appoint a health authority? Only if it has not established a local health department or a public health district and it is receiving a DSHS grant for essential public health services under 121.0065 HSC 121.028(b)

2/21/2019 V.G. Young School for County Commissioners Courts 30 HA Q & A What if my county has a health department? Then commissioners court appoints director of health department If director is physician, that person is also the health authority If not, director appoints physician as health authority (subject to comm. court and DSHS approval)

HSC 121.033 2/21/2019 V.G. Young School for County Commissioners Courts 31 HA Q & A What if my county is part of a public health district? Then members of public health district appoint director of district If director is physician, that person is also the health authority If not, director appoints physician as health authority (subject to district members and DSHS

approval) HSC 121.045 2/21/2019 V.G. Young School for County Commissioners Courts 32 HA Q & A What if my county does not have a health authority? Then the DSHS regional director* will perform the duties of a health authority HSC 121.007(c)

*regional director: physician employed by DSHS who serves as chief administrative officer of a region HSC 121.007(b) 2/21/2019 V.G. Young School for County Commissioners Courts 33 Required Forms Statement of Appointed Officer Must be completed & signed by Health Authority & submitted to Secretary of State before Certificate of Appointment & Oath of Office forms can be completed

Certificate of Appointment Must be completed by elected official within jurisdiction & mailed to DSHS Regional Office with Oath of Office Oath of Office Must be completed by Health Authority(with seal of person administering the oath visible) & mailed to DSHS Regional Office with Certificate of Appointment 2/21/2019 V.G. Young School for County Commissioners Courts 34 Health Authorities in Texas

Regional director performs HA duties Jurisdiction has own HA Source: DSHS (Sept. 2015) 2/21/2019 V.G. Young School for County Commissioners Courts 35 Legal Protections A health authority is a state officer when performing duties prescribed by state law. 121.024(a)

2/21/2019 HSC V.G. Young School for County Commissioners Courts 36 Legal Protections Sovereign Immunity (legal doctrine) Exception: Texas Tort Claims Act (TEX. CIV. PRAC. & REM. CODE ch. 101) Limitation on Liability for Public

Servants (TEX. CIVIL PRAC. & REM. CODE ch. 108) Medical Malpractice Act (TEX. CIVIL PRAC. & REM. CODE ch. 74) 2/21/2019 V.G. Young School for County Commissioners Courts 37 Legal Protections

Texas Disaster Act Local emergency planning committee member not personally liable for civil damages for an action arising from the performance of the persons duties on the committee (TEXAS GOVT CODE 418.174) 2/21/2019 V.G. Young School for County Commissioners Courts 38 Legal Protections

Texas Military Volunteer/public employee performing homeland security activity under state or local agency is considered member of Texas military forces ordered into active service (TEX. GOVT CODE 421.061) Member of Texas military ordered into service is not personally liable as an individual for good-faith act in an official capacity (TEX. GOVT CODE 437.222) 2/21/2019 V.G. Young School for County Commissioners Courts 39

Case Study Why have a health authority? Locally based Knows the community Familiar to local citizens & officials Can quickly respond in emergency 2/21/2019 V.G. Young School for County Commissioners Courts 40 Case Study In June 2011, children developed

vomiting, diarrhea, and fever after visiting a municipal swimming pool in San Patricio County. Their mothers contacted the county health department. The health authority, a family physician practicing in the community, immediately initiated a contact investigation and sent an inspector to check the pool. 2/21/2019 V.G. Young School for County Commissioners Courts 41 Case Study

Testing showed that there was no chlorine in the pool, and so the pool was closed. The HA notified the Regional Director. Over the next 24 hours, state, county, and local officials worked with municipal pool personnel to correct the problem. The pool reopened the next day. 2/21/2019 V.G. Young School for County Commissioners Courts 42 Case Study

A public health warning was issued concerning diarrheal disease and recommending control measures. As a result, other municipal pools in the county were inspected, and one temporarily closed because of inadequate chlorination. The outbreak subsided after 72 hours. Am J Public Health. 2012 July; 102(7): e21e26. 2/21/2019 V.G. Young School for County Commissioners Courts 43 Case Study

Corpus Christi Caller-Times June 14, 2011 Aransas Pass Aquatics Center reopens after reports of sick swimmers Workers replaced a faulty pump, which city officials said prevented chlorine from dispersing into the pool. Pool staff check the chlorine levels regularly, Winters said, but county health officials are looking at how levels dipped to zero and went unnoticed. We're trying to reconstruct exactly what went wrong, [Dr. James Mobley, medical director for the San Patricio County Health Department,] said. The important thing is to make sure this doesn't happen again. 2/21/2019

V.G. Young School for County Commissioners Courts 44 Summary Public Health Deals with community as a whole Helps improve life expectancy Focuses on prevention as well as treatment 2/21/2019 V.G. Young School for County Commissioners Courts 45

Summary Statutory Framework Counties may only do what state law says they can Counties may spend money on and enforce public health laws Counties may appoint health authority 2/21/2019 V.G. Young School for County Commissioners Courts 46 Summary Health Authority Physician appointed to 2-year term

State officer Duties: enforce health laws, quarantine, report disease outbreaks, assist DSHS Local presence 2/21/2019 V.G. Young School for County Commissioners Courts 47 Thank you dshs.texas.gov Mack T. Harrison Assistant General Counsel [email protected]

2/21/2019 V.G. Young School for County Commissioners Courts 48

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