Health Authority and the County

1. Health Authority and the County V.G. Young School for County Commissioners Courts February 21, 2019

2. Today’s Topics • Historical Background • Public Health • Statutory Framework • Health Authority • Q&A • Legal Protections • Case Study V.G. Young School for County Commissioners Courts

3. Historical Background Commissioners court • “shall exercise … powers and jurisdiction over all county business” Texas Constitution of 1876, Art. V, § 18(b) as amended V.G. Young School for County Commissioners Courts

4. 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 V.G. Young School for County Commissioners Courts

5. 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 V.G. Young School for County Commissioners Courts

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

7. Historical Background • 1989: Local Public Health Reorganization Act recodified as chapter 121, Health & Safety Code Acts 1989, 71st Leg. ch. 678 § 1 V.G. Young School for County Commissioners Courts

8. 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-Webster’s Collegiate Dictionary (11th Ed. 2004) V.G. Young School for County Commissioners Courts

9. Public Health health n 1 a:the condition of being sound in body, mind, or spirit; esp: freedom from physical disease or painb: the general condition of the body - Merriam-Webster’s Collegiate Dictionary (11th Ed. 2004) V.G. Young School for County Commissioners Courts

10. Public Health Individual • One • Narrow concerns • Anecdote Society • Many • Broad concerns • Data V.G. Young School for County Commissioners Courts

11. Public Health Medical Care • Focuses on individual • Vital to some at some times • Saves lives one at a time • Treats the condition V.G. Young School for County Commissioners Courts

12. Public Health Public Health • Focuses on society • Vital to allat all times • Saves lives all at once • Prevents, protects, and promotes V.G. Young School for County Commissioners Courts

13. 20th Century Life Expectancy Increase due to medical care advances: 5 years Increase due to public health measures: 25 years 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 V.G. Young School for County Commissioners Courts

14. 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” V.G. Young School for County Commissioners Courts

15. Statutory Framework Texas Health & Safety CodeChapter 122 • Authorizes commissioners court to “appropriate and spend money from the county general revenues for public health and sanitation in the county” V.G. Young School for County Commissioners Courts

16. 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” V.G. Young School for County Commissioners Courts

17. Statutory Framework Texas Health & Safety Code Chapter 121(Local Public Health Reorganization Act) • Describes qualifications and duties of a health authority V.G. Young School for County Commissioners Courts

18. Statutory Framework 25 Texas Admin. Code § 85.1 • Sets out rules for health authority V.G. Young School for County Commissioners Courts

19. Health Authority Physician* appointed under the Local Public Health Reorganization Act to administer state & local laws relating to public health within the appointing body’s jurisdiction HSC § 121.021 *physician: person licensed to practice by Tex. Med. BoardHSC § 121.002(2) V.G. Young School for County Commissioners Courts

20. 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 V.G. Young School for County Commissioners Courts

21. Health Authority Term of office • Two years • May be reappointed to successive termsHSC § 121.023 V.G. Young School for County Commissioners Courts

22. Health Authority Removal • For cause • Use county’s personnel procedures applicable to department heads HSC § 121.025 V.G. Young School for County Commissioners Courts

23. 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 25 TAC § 85.1(i) V.G. Young School for County Commissioners Courts

24. Health Authority “A health authority is a state officer when performing duties prescribed by state law.” HSC § 121.024(a) V.G. Young School for County Commissioners Courts

25. Health Authority Duties include • those necessary to enforce a law to protect public health • those prescribed by DSHSHSC § 121.024(b) V.G. Young School for County Commissioners Courts

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

27. Health Authority Duties include • reporting diseases, etc. • aid DSHS in enforcement • rules, ordinances, etc. • sanitation laws • quarantine rules • vital statistics collection HSC § 121.024(c) V.G. Young School for County Commissioners Courts

28. 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 V.G. Young School for County Commissioners Courts

29. HA Q & A When can my county directly appoint a health authority? • If it has not established a health department or public health districtHSC § 121.028(a) V.G. Young School for County Commissioners Courts

30. 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 § 121.0065HSC § 121.028(b) V.G. Young School for County Commissioners Courts

31. 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 V.G. Young School for County Commissioners Courts

32. 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 V.G. Young School for County Commissioners Courts

33. 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) V.G. Young School for County Commissioners Courts

34. 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 V.G. Young School for County Commissioners Courts

35. Health Authorities in Texas Regional director performs HA duties Jurisdiction has own HA Source:DSHS(Sept. 2015) V.G. Young School for County Commissioners Courts

36. Legal Protections “A health authority is a state officer when performing duties prescribed by state law.” HSC § 121.024(a) V.G. Young School for County Commissioners Courts

37. 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) V.G. Young School for County Commissioners Courts

38. 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 person’s duties on the committee(Texas Gov’t Code § 418.174) V.G. Young School for County Commissioners Courts

39. 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. Gov’t 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. Gov’t Code § 437.222) V.G. Young School for County Commissioners Courts

40. Case Study Why have a health authority? • Locally based • Knows the community • Familiar to local citizens & officials • Can quickly respond in emergency V.G. Young School for County Commissioners Courts

41. 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. V.G. Young School for County Commissioners Courts

42. 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. V.G. Young School for County Commissioners Courts

43. 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): e21–e26. V.G. Young School for County Commissioners Courts

44. Case Study Corpus Christi Caller-TimesJune 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.” V.G. Young School for County Commissioners Courts

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

46. 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 V.G. Young School for County Commissioners Courts

47. Summary Health Authority • Physician appointed to 2-year term • State officer • Duties: enforce health laws, quarantine, report disease outbreaks, assist DSHS • Local presence V.G. Young School for County Commissioners Courts

48. Thank you dshs.texas.gov Mack T. Harrison Assistant General Counsel mack.harrison@hhsc.state.tx.us V.G. Young School for County Commissioners Courts