CONTEXT The Public Health Accreditation Board (PHAB) began accepting applications for national voluntary accreditation in the fall of 2011. There are 3 prerequisites for accreditation: health assessments; health improvement plans; and strategic plans. These prerequisites must be in place for a state or local public health agency to apply for PHAB accreditation. Completion of the prerequisites can become a barrier for agencies that are considering applying for accreditation. OBJECTIVE This project looked at all 50 states through a legal lens to identify legal tools in the form of laws, rules, executive orders, contracts, legislative resolutions, and other tools that are used to authorize or require that a state or local health agency complete 1 or more of the prerequisites. DESIGN Using legal research platforms and a Boolean search stream, an inquiry of legal tools in all 50 states was completed to determine where legal tools are used to authorize or require the 3 PHAB prerequisites. Once legal tools were found, interviews were conducted with key informants from each state to understand the implementation and use of the legal tools found and collect any additional legal tools that were not found from the legal search. RESULTS The results include key findings and, importantly, an inventory of laws and legal tools that are being used around the country to require and support completion of the prerequisites. Within all 50 states, 26 states have some type of a mandate regarding 1 or more of the PHAB prerequisites. This includes 1 state that includes a mandate for PHAB accreditation. CONCLUSIONS States use a wide variety of legal tools to implement the prerequisites for voluntary accreditation. It is important to understand the interpretation, enforcement, and support of the laws and legal tools to determine whether the tools have impact in individual states.

S IN SOCIAL GERONTOLOGY, AGE AND AGEING, AGEING AND SOCIETY, AGING AND MENTAL HEALTH, JOURNAL OF AGING AND HEALTH, JOURNAL OF AGING AND SOCIAL POLICY, JOURNAL OF APPLIED GERONTOLOGY, RESEARCH ON AGING. 7 Stolle et al.: Integrating Preventive Law and Therapeutic Jurisprudence: A Law a Published by CWSL Scholarly Commons, 1997 CALIFORNIA WESTERN LAW REVIEW Medicare, private pensions, Social Security, and private benefits such as retail and service discounts, approaching age sixty-five may also bring the label of "elderly."33 The therapeutically insightful lawyer should be cognizant that being labeled elderly may have adverse consequences on an individual's self-image. However, the lawyer should also not overlook the reality that, as a matter of actuarial science, growing older is associated with an increasing potential for mental and physical health problems." Therefore, although the Burkes currently appear to be in relatively good mental and physical health, health maintenance might properly become a priority in their life. Second, the Burkes' concern about directing the distribution of their assets might itself raise therapeutic concerns. As evidenced by the Burkes' very presence in the lawyer's office, the Burkes have been contemplating the future, including the possibility of their own death or incapacity. Such concerns are common among older persons;' however, the topic of one's own death remains sensitive, and may often be accompanied by feelings of anxiety, uncertainty, or depression. The fact that the Burkes have never before consulted with a lawyer may also contribute to feelings of anxiety in discussing these private and emotionally charged issues. Third, the fact that Eleanor's mother is suffering from Alzheimer's disease should raise serious therapeutic concerns. Because Eleanor's mother is eighty-six years old and suffering from a severe neurological disease, she may have a very limited life expectancy. This raises the issue of the impact on Eleanor and Frank of witnessing Eleanor's mother's mental deterioration and coping with her eventual death. In addition to the difficult emotional and psychological circumstances the Burkes are facing, the continuation of adequate care for Eleanor's mother may have the potential to place an additional financial burden on the Burkes. Indeed, struggling with financing Eleanor's mother's care may place yet another psychological stressor on the Burkes. Finally, some evidence suggests that Alzheimer's disease may have a hereditary component.37 Eleanor's mother's condition thus ought to serve as a warning sign that Eleanor too may be at increased risk of developing 33. See Lawrence A. Frolik & Alison P. Barnes, An Aging Population: A Challenge to the Law, 42 HASTINGS L. J. 683, 684-87 (1991) (discussing "who really is elderly?"). 34. See generally id. 35. At the same time, it is critical that a lawyer not buy into stereotypes of the aged and avoid the "temptation to substitute decisions made by him or her for decisions that should properly be made by the client." JOAN M. KRAUSKOPF, ADVOCACY FOR THE AGING 24 (1983). 36. See Judith W. McCue et al., Disability Planning for the Senior Citizen, C126 ALIABA 339, 343 (1995) ("Increasingly, clients are concerned about the possibility of their own incapacity and wish to take steps to assure, should they become disabled in the future, that their assets will be protected and that health care decisions will be made on their behalf without court intervention or other delays.") 37. See generally Ge Li et al., Age at Onset and Familial Risk in Alzheiner's Disease, 152 AM. J. PSYCHIATRY 424 (1995). This is especially true of early onset Alzheimer's disease. Id. [Vol. 34 8 California Western Law Review, Vol. 34 [1997], No. 1, Art. 3 http://scholarlycommons.law.cwsl.edu/cwlr/vol34/iss1/3 19971 PREVENTIVE LAW & THERAPEUTIC JURISPRUDENCE 23 Alzheimer's disease in later life. 38 Fourth, Frank's arthritis should raise therapeutic concerns in the mind of the preventive lawyer. Arthritis is a chronic disease that often contributes to future disability among older persons39 and is a characteristic impairment of "consistently high users" of medical services." Furthermore, the severity of an arthritic condition is related to a decline on some measures of psychological well-being." In Frank's case, an increase in the severity of his arthritic condition may infringe on his woodworking hobby and, consequently, have a particularly detrimental impact on his psychological wellbeing. Stolle suggested that, by keeping abreast of social scientific literature on geriatric issues, a preventive lawyer, as a first step, can identify therapeutic concerns such as those listed above. 2 The presence of such therapeutic issues should suggest to the TJ preventive lawyer that planning for the possibility of future incapacity or disability should be important in working with the Burkes. Thus, the lawyer should discuss therapeutic goals openly with the Burkes as one potential consideration in their planning. This conversation must, of course, be conducted in a sensitive and respectful manner. However, the client should be involved from the beginning in the identification of therapeutic concerns. On one hand, the lawyer should encourage the Burkes to consider the real possibility of future incapacity. A detailed client interview and a discussion of the clients' plans can provide an opportunity for the Burkes to take a realistic look at their own health and the possibility of declining health in upcoming years. On the other hand, the lawyer should also encourage the Burkes to value their current healthy condition, and might even use this opportunity to encourage the Burkes to make health maintenance a priority. Here, the lawyer is clearly stepping outside of his role of legal counselor, and should make that absolutely clear to the client.43 The lawyer 38. See generally id. 39. See generally Susan L. Hughes et al., Impact of Joint Impairment on Longitudinal Disability in Elderly Persons, 49 J. GERONTOLOoY S291 (1994). 40. Donald K. Freeborn et al., Consistently High Users of Medical Care Among the Elderly, 28 MED. CARE 527 (1990). 41. See Barbara L. Downe-Wamboldt & Patricia M. Melanson, Emotions, Coping, and Psychological Well-Being in Elderly People with Arthritis, 17 W. J. NuRsING REs. 250 (1995); Baqar A. Husaini & Stephen T. Moore, Arthritis Disability, Depression, and Life Satisfaction Among Black Elderly People, 15 HEALTH & Soc. WoRK 253 (1990). 42. See Stolle, Professional Responsibility, supra note 2. 43. This point represents a refinement of the analysis presented in Stolle, Professional Responsibility, supra note 2. Although TJ preventive lawyering involves an expansion of the role of the lawyer as counselor, the TJ preventive lawyer's expertise has clear limits. When the lawyer chooses to give advice or suggestions falling outside of that area of expertise, the lawyer must make clear that his role in giving that advice is as a friend or acquaintance, not an expert. Furthermore, any such advice should be restricted to general and innocuous state-

Alternatives to the High Cost of LitigationVolume 11, Issue 11 p. 154-160 Health Industry Dispute Resolution Strategies and tools for cost-effective dispute management† Edward A. Dauer, Edward A. DauerSearch for more papers by this authorFrancis Flaherty, Francis FlahertySearch for more papers by this authorCatherine Cronin-Harris, Catherine Cronin-HarrisSearch for more papers by this author Edward A. Dauer, Edward A. DauerSearch for more papers by this authorFrancis Flaherty, Francis FlahertySearch for more papers by this authorCatherine Cronin-Harris, Catherine Cronin-HarrisSearch for more papers by this author First published: November 1993 https://doi.org/10.1002/alt.3810111109Citations: 1 † © Copyright 1993 by Center for Public Resources/CPR Legal Program, New York, NY. All rights reserved. Member Distribution: CPR Members may reproduce all or part of this document for dissemination within their company or law firm. Professional Services: Lawyers may reproduce all or part of this document in performing professional services for their clients. Non-Profit Use: Permission to reprint this document for all non-profit purposes, including but not limited to speeches, articles, conferences, training or similar presentations, is given on the following conditions: (a) CPR's copyright and permission appear on the first page on which the CPR material appears; (b) the document is used in its entirety; and (c) CPR receives notice of intended use and a copy of the text in which the CPR material is included (Att'n: C Harris). For-Profit Use: No part of this document may be reproduced in any form for for-profit publication without the prior written permission of CPR. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume11, Issue11November 1993Pages 154-160 RelatedInformation

Successful joint defense agreements require a procedure by which settlements or adverse judgments can be allocated among the participating defendants. Such agreements usually preclude inter-defendant argument during the principal trial; as a result, neither a judgment nor the terms of a prudential settlement are useful as a guide to allocating the joint loss among the participants. Submitting claims (for contribution) to formal litigation after the principal trial defeats the purpose of the joint defense agreement vis-a-vis future plaintiffs. Hence the need for a private ADR (Alternative Dispute Resolution) procedure. The following pages outline an ADR procedure specially tailored to the needs of multi-party or multi-chemical toxic tort litigation. The components of the process are largely well known ADR techniques, supplemented by a novel science process that addresses the unique characteristics of the allocation problem in instances of scientific uncertainty or disputed scientific causality. The process is only partly binding; while it permits litigation as a last resort, it imposes sanctions on its use. The multiple-defendant and often multiple-chemical dimensions of the underlying litigation also call for practical groupings of interests, to keep the complexity of the process manageable. How those groups are assembled, when necessary, is a matter of negotiation in each case. Other selected features of the process are discussed in additional, although still brief, detail in these pages.