Model Aquatic Health Code

Transcription

1 Model Aquatic Health Code American Society of Law, Medicine & Ethics Network for Public Health Law Public Health Law Association Public Health Law Research Program The legal information and assistance provided in this webinar does not constitute legal advice or legal representation, nor reflect the opinion of the series partners.

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4 Panel: Jasen Kunz Lieutenant Commander (LCDR) Commissioned Officer, United States Public Health Service Doug Farquhar Program Director, National Conference of State Legislature s Environment, Energy, and Transportation Area,

5 The Model Aquatic Health Code: A Tool to Improve Health In Your Jurisdiction LCDR Jasen Kunz Environmental Health Services Branch Network for Public Health Law Webinar August 16, 2012 Centers for Disease Control and Prevention Model Aquatic Health Code

6 Health Benefits of Swimming One of the most popular sports in the US more than 300 million visits a year 2 ½ hours / week can decrease risk of chronic illness and improve health for those with diabetes & heart disease People report enjoying water-based exercise more than exercising on land and can exercise longer without increased effort or joint or muscle pain

7 MODEL AQUATIC HEALTH CODE (MAHC): GENESIS AND BEGINNINGS

8 Healthy Swimming Beginnings What made CDC think there was an issue? Drinking water outbreaks caused by Cryptosporidium 1994, CDC investigated large lake-associated outbreak of cryptosporidiosis in NJ 1995, CDC investigated a large (>5000 people) of cryptosporidiosis at a waterpark in GA Increases in # of outbreaks, particularly GI illness Large, high profile outbreaks

9 Number of outbreaks Recreational Water Illness Outbreaks of Cryptosporidiosis, by Water Treatment and Year United States, Treated: Pool, water parks, interactive fountains Untreated: Lakes, oceans, rivers Year * N=153, Hlavsa MC et al MMWR 60(SS-12):1 39.

10 MAHC Genesis 2004, CSTE Position Statement called for CDC to sponsor a national workshop 2005, CDC held Recreational Water Illness Prevention at Disinfected Swimming Venues ; Atlanta, Georgia Create resource to assist state/local health departments in creating or updating their codes Cover disease, injuries, & drowning prevention Make it data-driven, knowledge-based Update regularly based on new data Give open access to all users

11 MAHC DATA IMPACT VIGNETTES

12 Operator Training Issue Operating a pool is a complex job requiring knowledge of engineering/plumbing, pool chemistry, filtration and flow calculations, disease transmission, injury prevention Many codes require no pool operator training, particularly for hotels, motels, apartments, condos

13 RWI Outbreaks of Gastroenteritis Associated with Treated Recreational Water United States, (n=164) Chlorine sensitive: Poor pool operation & maintenance Shigella 4.9% Norovirus 5.5% E. coli 2.4% Giardia 3.0% Other 3.0% Unknown 6.7% Other includes Campylobacter, Salmonella, Plesiomonas, and multiple pathogens Cryptosporidium ( Crypto ) 74.4% Source: Hlavsa MC et al MMWR 60(SS-12):1 39. Chlorine tolerant

14 Inadequate Pool Operation and Maintenance is Common Pool inspection data from 4 state and 11 local U.S. pool inspection programs Data from >120,000 pool inspections 1 Conducted January 1 December 31, % (1 of 8) of routine inspections resulted in immediate closure pending correction of violation CDC. MMWR Morb Mortal Wkly Rep. 2010;59;

15 Operator Training Data supporting action Trained operators have fewer critical disinfectant violations such as ph/chlorine (e.g., ph/free Cl, aor 2.2; 95%CI= ) (Buss) Training significantly reduces ph, combined chlorine violations (p<0.05) (Johnston) Certified kitchen manager (CKM) on duty reduces some critical inspection violations (p<0.05) (Cates) CKM on duty protects against outbreaks (OR 0.2; 95% CI = 0.1 to 0.5) (Hedberg)

16 Operator Training MAHC Response A QUALIFIED OPERATOR shall be available onsite during all hours of operation at the following aquatic facilities: All other AQUATIC FACILITIES as specified must have an on-site QUALIFIED OPERATOR or a contract with a QUALIFIED OPERATOR for a minimum of weekly visits and assistance whenever needed.

17 Can Basic Hygiene Make a Difference? Did the water just get warmer around here?

18 Issue Basic Hygiene: Clean it Up America! Swimming is communal bathing >300 million annual visits in US Cater to young children-- incontinent 20% of adults don t know that people should not swim when ill with diarrhea Few people shower or bathe before swimming

19 Basic Hygiene: There are Some Things You Would Rather Not Share! Data 5% of general public had diarrhea in past month cases of diarrhea/person/year (higher for young children) 2 ~0.14g of feces on peri-anal surface/person Range: 0.01g (adults) 10g (children) 3 1 of 5 adult respondents admit peeing in the pool, 78% believe others do it 4 >300 million annual communal bathing visits in US 1. Jones TF et al Epidemiol Infect 135(2): Roy SL et al J Water Health 4(Suppl 2): Gerba CP Quant Microbiol 2(1): Wiant C. Int J Aquatic Res Ed 2011;5:

20 Swallowing Recreational Water is Common: Water Swallowed While Swimming, by Age Group 1 Group Adults Non-adults Average Amount of Water Swallowed (ml)* 16 (0.5 fluid ounces) 37 (1.3 fluid ounces) Range (ml) * Swimmers stayed in pool and actively swam for >45 minutes. 1. Dufour AP et al J Water Hlth 4(4):

21 Basic Hygiene and Pool Etiquette MAHC Response Diaper changing station required (based on child care experience) Safe area, adjacent sink, soap dispenser, footoperated trash can, disinfectant to clean up, signage Rinse showers by pool approved along with cleansing showers Minimum distances to restrooms ( ft) Employee illness policy required Pool breaks, signage Patron education suggested

22 Drowning Issue 2 nd leading cause of unintentional death from injury (behind motor vehicle crashes) for ages 1-14 More than 50% of drowning victims treated in emergency departments require hospitalization or transfer for further care. These injuries can cause severe brain damage and long-term physical and mental disabilities Deaths more common in males and African Americans (particularly ages 5-14)

23 Child drowns in Brooklyn Park pool Sampling of Recent Drowning Headlines Massachusetts Woman Dead in Public Pool for Two Days ABC News, June 30, 2011 Student drowns in high school pool in Conn Eyewitness News, January 13, Man reported hospitalized after near drowning Times Record News, July 15,

24 Data supporting action Drowning Death and injury most common among 0-4 year olds Pools most common location for drowning for 0-4 year olds Not just residential pools Environmental protections - including fencing and lifeguards - are key to prevention CDC. Drowning United States, MMWR May 18, 2012 / 61(19);

25 Drowning MAHC Response (Lifeguarding and Bather Supervision): Standards for which aquatic facilities need professional lifeguarding versus other supervision An Aquatic Facilities Safety Plan guide Requirements to define and document zones of patron surveillance Determination of proper staffing (lifeguards need to be able to reach all within their zone quickly) Required lifesaving equipment, communications standards, and training requirements

26 Drowning MAHC Response Design & Construction Fencing Drain covers Design and construction elements such as depth markings, floor slopes, lighting requirements, material colors and rest ledges.

27 FUTURE CONSIDERATIONS

28 14 modules Progress 12 posted for public comment, 2 in CDC clearance 2 in final editing Text available: ~833 pages Code: 335 pages, Annex: 498 pages Currently addressing all public comments for revision Timeline All modules posted by end of summer 2012 Complete synthesized MAHC posted by end of 2012 Complete 1 st edition of MAHC by 2013 swim season

29 Implementation Expectations 2001 CDC Fecal Incident Response guidelines 2002: 25 states instituted new policy in past year, 21% used CDC policy 2006: all states have policy, all follow basic CDC parameters Engaged Public Health Law Program Informational materials for boards of health and other implementers to explain intent and use of MAHC User Guide forthcoming NALBOH involvement

30 Interactions with Other Codes ICC/IAPMO (International Code Council; International Association of Plumbing and Mechanical Officials) Work to minimize conflict and overlap CDC recently signed MOUs with both groups CDC voting member of both groups and will begin to engage on committees for code writing

31 Potential Health Outcomes Fewer outbreaks of waterborne illnesses resulting from exposure to contaminated swimming water Fewer drowning injuries & deaths in aquatic facilities Fewer emergency room visits for swimming-related issues Fewer injuries associated with pool chemicals Fewer closures of pools due to imminent health hazards

32 Impact Measuring Impact CDC has a direct and continuing role in the effort to be evaluated Monitoring and evaluation Developing plan for monitoring dissemination of MAHC (codes, bill introductions/enactments) Plan for monitoring impact on critical pool inspection parameters, injuries, drowning, waterborne illness, outbreaks Research Plan Gaps apparent when writing code but gaps offer opportunity for seeking further information to strengthen or change code

33 Website: "The findings and conclusions in this presentation have not been formally disseminated by CDC and should not be construed to represent any agency determination or policy." Centers for Disease Control and Prevention Model Aquatic Health Code

34 Legal Concerns regarding Aquatic Venues Doug Farquhar, J.D. August 17, 2012

35 National Conference of State Legislatures (NCSL) Non-profit, bi-partisan organization of state legislatures Members are all 50 state legislatures, 7,400 legislators and 30,000 legislative staff in 50 states, D.C. and U.S. territories. Quebec, Alberta and Scotland are members Offices in Denver and D.C. Among our goals - To provide legislatures with information and research about policy issues, both state and federal. NCSL tracks state policy developments in all public policy areas.

36 Risks to Public/Private Venues o How can an Aquatic Venue be liable? By operating a venue that is accessible oto the public oto paying patrons oto trespassers o Aquatic Venues are, by their nature, dangerous Injuries from drownings Slips and falls Chemical maintenance Public health threats

37 Can you Limit Liability? o Signage "There is no Lifeguard Present" "No Diving" o Supervision Properly trained lifeguards Properly trained operators o Restricting Access Fences, Gates, Enclosed Facilities o Signing away rights Country Club members promise not to sue

38 Lawsuits against Aquatic Venues o August 2010, Arizona attorney Kristin Rooney filed a $26 million wrongful death claim on behalf of the family of 16-year-old Jesus Jesse Prado, who died May 14, 2010 o April 2008,Vincent Agwouke, 17, drowned in the swimming pool at Westside High School after he and several other students jumped in, following a science experiment. o 12 yr old drowned on a field trip, parents sued the city of New York for $20 million. No Lifeguard on duty

39 Lawsuits Against Aquatic Venues o Mt. Laurel, PA pool sued for $100,000 Man was running, injured while jumping into pool Pool closed due to fear of lawsuits o Improper Pool Markings Lead to Quadriplegia: $5.2 million verdict for a young man who dove into the shallow end of a hotel swimming pool The pool was not properly marked to identify the depth and restrictions on diving o Improper Supervision at Daycare leads to Neardrowning: 6 yr old girl who was attending "swim time" at her day care, she was left unsupervised in the pool

40 Lawsuits Against Aquatic Venues o Seneca Lake State Park, Geneva, NY Spray Park with Cryptosporidium 4000 cases before closed by the NY DoHealth 2538 patrons represented by one lawfirm Marler Clark o Wading Pool in Cobb County, GA E. coli 0157:H7 Ga. DofHealth found no Chlorine Violation of County Rules County Negligent

41 Legal Standard of Care o Plaintiff was injured o The product was defective o The defect caused the injury Legal Precedence has a wider application in areas without statutory standards CA Parks and Recreation Society

42 Legal Standard of Care o Reasonable Person: the degree of care that a person or ordinary prudence would exercise in the same or similar circumstances; the standard which a property owner must observe to avoid liability for injuries to patrons o Determined by court cases (legal precedence), the foreseeability of harm to the plaintiff Did the owner know or should they have known that their venue could cause an injury? But-for the actions by the operators of the venue, would the plaintiff be injured?

43 Statutory Standard of Care o Based on Statutory or Regulatory law; takes precedence over legal standard of care o Determined either by agency personnel through regulatory process, or mandated by legislature, local council or Congress in statute/ordinance Specifies the standard of care that an aquatic venue should meet Sets requirements for local/state enforcement Defines the legal standard of care

44 Industry Standard of Care o The Model Aquatic Health Code (MAHC) Developed by CDC and industry leaders Available for adoption by jurisdictions Sets a new standard of care o International Code Council Aquatic Standard Available for adoption by jurisdictions Jurisdictions can adopt ICC standards by reference o Illegal Delegation of Authority Sets a new standard of care

45 Efforts to Adopt the MAHC o Jurisdictions with antiquated aquatic codes Kentucky last major update 1988 California last updated 1986 o Jurisdictions in process of code revisions Iowa Pool Code Revision o Req's OT, MAHC Operator Training Module Michigan has discussed Operator Training Ohio Legislature had hearing on Operator Training o HB Public Pools, Spas, Special Use Pools

46 Efforts to Adopt the MAHC o California Swimming Pool Code Regimen The state regulates pools via a series of regulations o 5 H&S Codes o 1 Code of Regs (CCR tit. 22) o 1 Building Code (CBC tit. 24) CCR tit. 22 does not require O&M training Doesn't address current health & safety stds o no rules for fecal/vomit/blood releases

47 Efforts to Adopt the MAHC o California A.B (2012 Sess.) Sponsor Assemblyman Michael Allen Required O&M Training for Aquatic Venues o exempted Apts, RV Parks and Special Water Attractions o Counties could be more stringent (LA County) Survived Health Committee; stalled in Appropriations

48 Efforts to Adopt the MAHC o Kentucky Code Revision Dept. of Public Health has authority to revise codes o No fecal accident policy (CDC 2000) o does not cover splash pads Discussed MAHC as option Louisville Metro has OT requirements; Lexington does not

49 Policy Implications o Insurance may require a property to meet state/federal /industry standards Coverage determined by adoption of standard o Lending Institutions may require properties meet a standard Mortgage affected by adoption of standard o Courts may accept a state/federal/industrial standard as legal standard of care Juries may find that standard available, not followed, led to injury Aquatic Venue at fault pay up!

50 Policy Implications Who is at fault? Owner of the Venue Operator of the Venue State Health Department Local Health Department Product Manufacturer Product Applicator Construction Company Architect Insurance Company

51 States That Don t Require Operator Certification Required Training Knowledge Required No Requirement 26 States don t require Operator Training

52 Conclusion Adoption of a standard lessens liability and insurance risk. Creates a uniform standard of care. Defines assumable risk for aquatic venues v. relying on juries or judges. Many questions linger This is inherently a state/local issue, not federal Will the MAHC take precedence? Will the MAHC be able to address novel outbreaks? Can the MAHC protect the aquatic industry from being sued out of existence?

53 Contact Information/Questions Doug Farquhar, JD National Conference of State Legislatures

54 Question & Answer Type your question in through the Q and A panel