The Indiana Public Health Association & Indiana State Association of City and County Health Officials gave its thumbs up after Gov. Eric Holcomb on May 4 vetoed legislation that would limit local health departments’ powers.
“We very much appreciate Governor Holcomb’s decision to veto this dangerous legislation and prioritize the health and safety of Hoosiers,” the association’s statement read. “We also hope Indiana legislators will give serious consideration to the Governor’s position when deciding on any future action.
“Guided by facts, science and a single-minded mission to keep our communities healthy, local public health officials and our broader public health partners take very seriously the responsibility to protect human health and the important balancing act between science, economic impact and personal freedoms.”
Indiana’s public health officials had warned about unintended consequences in their ability to issue and enforce emergency health orders if changes in Indiana Senate Bill 5 went through.
The bill, which was crafted primarily as a check in response to COVID-19 restrictions, stated that a local order regarding an aspect of a declared emergency addressed by an executive order could not exceed the latter. A health order also couldn’t go into effect if no executive order on the matter was in place.
Holcomb, in a letter to Senate President Pro-Temp Rodric Bray, cited how well economically Indiana has come through the COVID-19 pandemic and stated among his reasons for the veto that local health officials must “use localized data to tailor their decisions to their community’s needs. ... One reason Indiana has weathered the storm so well is due to coordination with local health experts and the flexibility in law to be fast, nimble and targeted.”
The bill had among its co-authors Sen. Liz Brown, R-Fort Wayne; Sen. Travis Holdman, R-Markle; Sen. Sue Glick, R-LaGrange; Sen. Dennis Kruse, R-Auburn; Sen. Justin Busch, R-Fort Wayne; and had among its sponsors Rep. Matt Lehman, R-Berne.
The Indiana General Assembly passed the bill before adjourning the last week of April.
Dr. Jeremy Adler, the Tippecanoe County health officer and representative of the Indiana State Association of County and City Health Officials had highlighted three main grievances with the bill in its current state:
• Shifts control of major public health decisions to elected officials, who generally lack the expertise in specific public health topics
• Shifts appeals of public health orders from the court system to county government, creating the need for a new government layer to respond to appeals
• Allows establishments who choose to appeal a public health order to remain in operation while the appeal is being processed, potentially allowing a threat to public health to continue for days, weeks or months as the issue is litigated locally
The bill covers “any aspect of a declared emergency that is not addressed by an executive order or if a local order addresses an aspect of a declared emergency more stringently than an executive order,” which health officials warned expands its scope just beyond the current or any future pandemic declared by the governor.
“Indiana Senate Bill 5 would be a dangerous experiment Hoosiers would soon regret,” Adler said.
Dr. David Welsh, health officer for Ripley County, elaborated on those points, noting that public health leaders frequently communicate and collaborate widely with other local leaders and weigh the impacts of health orders and when they need to be issued.
“Local public health officials take very seriously their role to protect the public health and make sure the economic impact is minimized and personal freedoms are maintained,” Welsh said. “We’ve been successful because all the stakeholders have been working together.”
But Welsh also reminded that the role of the health department extends well beyond just COVID-19, which has been a main focus over the last year.
The county health department also oversees sewage; water safety both in natural bodies, municipal water systems and public amenities like pools and water parks; and, commonly, food safety.
Speed is critical in public health and stripping public health officials of the ability to enact their own emergency orders. For example, if a disease outbreak occurs at a restaurant, that eatery needs to be shut before people can eat them and potentially get ill.
“We need to act quickly to prevent that spread in the community. When something happens, we have to act,” he said.
Rules that would allow an establishment to remain open during an appeal could potentially allow harm to continue while the appeal is processed, he said.
The IPHA identified that provision as its top concern with the bill and will be lobbying to have it removed, as it had been in a House version, during the upcoming conference committee.
Dr. Paul Halverson, founding dean of the IUPUI Richard M. Fairbanks School of Public Health, speaking for himself and not on behalf of the university, also stated that rules that limit more stringent restrictions on the local level run counter to the notion that public health is often a local or regional issue.
Even as seen through the COVID-19 pandemic, not all communities are affected equally. So making it harder for a local community experiencing a problem to tailor a response to its situation is counterproductive.
“That defies the whole notion around local control and local customized interventions. The entire state doesn’t suffer uniformly from disease outbreaks,” Halverson said. “To essentially say from the very beginning that unless the entire state is in a severe situation then no one should be essentially ignores the science of public health, which says we need to match the intervention to the need.”
Assuming difference between House and Senate versions are smoothed out and the bill becomes an enrolled act, public health officials will urge Gov. Eric Holcomb to veto it.
“It seems the legislature is going to pass Senate Bill 5, our hope is to reach out to the governor and ask that he veto it when/if it reaches his desk,” said Susan Jo Thomas, outgoing president of the IPHA. “This is not the time we should be pitting against each other elected officials and public health officials.”