New Mexico Updates Critical Public Health Legal Infrastructure

June 29, 2017|3:17 p.m.| Dawn Hunter, New Mexico Department of Health

On April 6, 2017, New Mexico Gov. Susana Martinez signed SB 223, updating the state’s public health laws to “reflect current best public health practices, support the provision of services and infrastructure necessary to address emerging public health threats, and improve health outcomes for all New Mexicans.”

Key changes to the law include:

  • Clarifying the New Mexico Department of Health’s (NMDOH) authorities and responsibilities so they more accurately reflect current programs, activities, and the essential public health services.
  • Shifting reportable conditions laws from disease-specific to a new framework that defines conditions of public health importance by updating language authorizing NMDOH to establish and maintain a list of notifiable conditions and associated reporting requirements, and by enacting new statutes related to testing and screening procedures.
  • Granting NMDOH authority to issue emergency public health orders for quarantine or isolation for 24-hours and outlining the due process and other protections for individuals under such orders.
  • Aligning state laws with federal laws and national initiatives, including the Health Insurance Portability and Accountability Act, public health department accreditation, and the Model State Vital Statistics Act.
  • Updating statutory programs, such as the school nurse and EMS programs, so the legal basis accurately reflects changes that have occurred with the programs over time.
  • Modernizing terminology, such as replacing “sexually transmitted disease” with “sexually transmitted infection” and “Indian” with “Native American,” and making references to the secretary of health gender-neutral.

This law has been at least four years in the making. In 2013, NMDOH commissioned an assessment of New Mexico’s public health laws as part of its public health department accreditation submission. For accreditation, health departments document their engagement across 12 domains, including Domain 6: Enforce Public Health Laws. The assessment compared New Mexico’s laws with the Turning Point Model State Public Health Act and recommended ways to reform, improve, and update the laws to align them with current practices in the department, as well as evolutions in the public health field.

In 2014, I joined NMDOH as a Robert Wood Johnson Foundation and Network for Public Health Law Visiting Attorney and translated the assessment’s recommendations into legislative language with the buy-in of frontline staff and policymakers at all levels of the state. I met frequently with internal stakeholders to share the assessment and recommendations and ensure that proposed changes worked for the impacted programs.

Following these conversations, I organized the recommendations by five overall themes and identified five possible approaches to implement them. View a matrix with examples of the recommendations (rows) and the approaches (columns) here.

Considering political feasibility, NMDOH kept a narrow focus on modernization and made thoughtful choices about how to include politically sensitive reforms. The NMDOH Office of General Counsel and the policy director reviewed and prioritized the proposals, and I translated them into draft legislative language, which were then approved as Cabinet-level legislative proposals for the 2015 session. I joined NMDOH staff in January 2015, which was fortunate for continuity. 

Sen. Daniel Ivey-Soto sponsored the bill and served as a strong champion throughout the process. He worked closely with NMDOH to refine the initial proposals. Ivey-Soto and NMDOH made a strategic decision to introduce one comprehensive bill rather than several smaller bills, and the bill did not attract substantial attention. There was general interest in the isolation and quarantine updates in light of the Ebola outbreak in 2014, as well as some opposition to provisions requiring participation in the state’s immunization registry. The registry provisions were ultimately removed in committee. In addition, there was no fiscal impact because the bill aligned the law with existing practices. Although the bill was not enacted, it passed the Senate and also made headway in the House.

Because of this early success, the bill was reintroduced in the 2017 session. Using the last committee-approved version of the 2015 bill, I met with stakeholders to review the changes the legislature made and discuss whether to keep those changes. Minor edits and additions were also made based on stakeholder feedback, such as correcting the definition of “screening.” Sen. Ivey-Soto returned as the primary sponsor, and the bill passed both chambers unanimously.

The law became effective on June 16, 2017, and NMDOH looks forward to having additional clarity in terms of reportable conditions and an isolation and quarantine law that better balances the protection of public health with individual rights. NMDOH continues to discuss how to incorporate systematic reviews of laws and policies so the legal framework continues to effectively support public health.

For jurisdictions interested in addressing similar issues, NMDOH recommends compiling existing laws and comparing them against a standard, like the Model State Public Health Act. The NMDOH was fortunate to have a third-party conduct its assessment, but the process can also be done internally. This assessment helps identify gaps and needs, areas ripe for modernization, and duplicative or inconsistent definitions and provisions. Second, engaging internal stakeholders throughout the process secures buy-in and results in changes that improve day-to-day operations.

The following resources were helpful throughout the process:

 

Dawn Hunter is the director of the office of policy and accountability at New Mexico Department of Health and serves on ASTHO’s legislative liaison peer network.