试论卫生监督执法之调查取证

<正>调查取证是指行政机关对于立案处理的案件,为查明案情、收集证据和查获违法行为人而依法定程序进行的专门活动和依法采取的有关强制措施。行政处罚必须遵循“先取证、后裁决”的原则,在案件违法事实清楚,证据确凿的情况下实施处罚,因此,调查取证是卫生行政机关正确实施行政处罚,维护正常卫生秩序的前提和基础。现通过两个案例的分析,结合卫生监督工作实践,谈一下卫生监督执法中调查取证应遵循的几个原则,与同行共同商榷。     

卫生监督执法体制改革思路

卫生监督体制改革是转变卫生防疫机构职能 ,加强卫生监督执法工作的一项重大改革。根据卫生部要求 ,结合宁夏实际 ,提出我区卫生监督体制改革的基本思路。一、卫生监督现状及体制改革的必要性(一 )卫生法律体系逐步完善１９８２年《食品卫生法 (试行 )》颁布 ,赋予卫生防疫站食品卫生监督执法权和卫生行政部门对食品卫生监督工作的领导职责 ,标志着卫生工作由过去的行政管理走上了法制管理的轨道。此后 ,全国人大又陆续颁布了《药品管理法》、《国境卫生检疫法》、《传染病防治法》、《母婴保健法》、《红十字法》、《献血法》和《执业医师…     

卫生监督执法信息系统在卫生监督执法中的应用

为提高卫生监督执法效率,加快卫生监督执法信息化建设,我们开发应用了卫生监督执法信息系统.卫生监督执法信息系统以现场卫生监督、执法业务为核心,以提高卫生监督所的监督执法水平和管理水平为目标,实现卫生监督执法工作及相关管理工作的信息化管理和区域卫生监督执法信息共享.     

卫生监督体制改革中执法职责的划分

<正>当前卫生监督体制改革中,如何划分卫生监督和疾病控制的职责是体制改革中的重要内容,过去防疫站中食品卫生执法工作相对较强,也比较好划分。但传染病、学校卫生、劳动卫生执法较弱,防病任务重,其主要工作过去也多有防病科室承担,体制改革中这些科室也多留在了疾控机构。因此,正确划分职责、分清任务,对体制改革中保持工作的连续性,提高工作水平,强化防病效果尤为重要。下面重点围绕此三项工作职责、任务的划分,结合青岛市的改革实践做一初步探讨。     

新时期卫生监督执法的思考

在卫生监督体制改革的时期 ,如何通过改革提高卫生部门的执法能力 ,规范卫生执法行为 ,塑造卫生执法队伍良好形象 ,树立卫生执法威信 ,扩大卫生执法影响是摆在我们面前的实际问题。作者通过当前工作实际探讨卫生监督执法思路 ,以使新时期卫生监督执法工作沿着规范、有力、高效、简捷的方向发展 ,更好地服务于经济建设和人民健康。     

卫生监督体制改革模式的探究

简述了我国现行卫生监督体制存在的主要问题,讨论了我国公共卫生监督执法有关“热点”观念,提出了卫生监督执法体制改革模式的设想。     

浅谈卫生监督执法实行执法责任制的必要性

本文阐述卫生监督执法应实施执法责任制的必要性,实施的具体内容和意义,以及初步实施后的工作体会和建议。     

安阳市公共卫生行政执法文书制作情况调查分析

卫生行政执法文书是卫生行政机关为实现卫生行政监督管理职能,在现场卫生监督、行政处罚过程中制作的法律文书,是各级卫生行政执法人员落实卫生法律法规的法律凭证,文书制作是否规范直接影响着执法行为的效力。为了解安阳市卫生行政执法文书制作情况,对2006—2007年公共卫生行政执法文书进行调查分析,结果报告如下。     

Enforcement of Ohio's Smoke Free Workplace Law Through the Lens of Public Health Practice

Objectives

Little is known about whether public health (PH) enforcement of Ohio''s 2007 Smoke Free Workplace Law (SFWPL) is associated with department (agency) characteristics, practice, or state reimbursement to local PH agencies for enforcement. We used mixed methods to determine practice patterns, perceptions, and opinions among the PH workforce involved in enforcement to identify agency and workforce associations.

Methods

Focus groups and phone interviews (n=13) provided comments and identified issues in developing an online survey targeting PH workers through e-mail recruitment (433 addresses).

Results

A total of 171 PH workers responded to the survey. Of Ohio''s 88 counties, 81 (43% rural and 57% urban) were represented. More urban than rural agencies agreed that SFWPL enforcement was worth the effort and cost (80% vs. 61%, p=0.021). The State Attorney General''s collection of large outstanding fines was perceived as unreliable. An estimated 77% of agencies lose money on enforcement annually; 18% broke even, 56% attributed a financial loss to uncollected fines, and 63% occasionally or never fully recovered fines. About half of agency leaders (49%) felt that state reimbursements were inadequate to cover inspection costs. Rural agencies (59%) indicated they would be more likely than urban agencies (40%) to drop enforcement if reimbursements ended (p=0.0070). Prioritization of SFWPL vs. routine code enforcement differed between rural and urban agencies.

Conclusions

These findings demonstrate the importance of increasing state health department financial support of local enforcement activities and improving collection of fines for noncompliance. Otherwise, many PH agencies, especially rural ones, will opt out, thereby increasing the state''s burden to enforce SFWPL and challenging widespread public support for the law.In November 2006, 58% of Ohio voters approved the Smoke Free Workplace Act, making Ohio one of 36 states to pass legislation regarding indoor tobacco exposure in workplaces and the 12th state to protect all citizens from secondhand tobacco smoke exposure in public places and most workplaces.^1–4 Implemented on May 3, 2007, the Smoke Free Workplace Law (SFWPL) limits tobacco use in about 280,000 places of employment and public places in Ohio. Private residences, family-owned businesses without non-family employees, certain areas of nursing homes, outdoor patios, and some retail tobacco stores were exempt.⁴ In 2007, 23.1% of Ohioans were current smokers, which was a significantly higher percentage than for the U.S. population as a whole (19.8%).⁵State and local public health (PH) agencies were charged with SFWPL enforcement. Local PH departments (agencies) choosing to enforce SFWPL could be reimbursed $125 by the Ohio Department of Health (ODH) for each completed investigation that had all required notifications filed within 50 calendar days of an initial issuance. Punitive fines to violators ranged from a warning letter to a $100, $500, $1,000, or $2,500 fine for the fifth and subsequent violations.^6,7 Inspectors could double fines for intentional violations and assess daily fines for continuing violations. Outstanding obligations could be turned over to the State Attorney General''s (AG''s) office for collection.⁸Upon implementation, several PH agencies opted out, requiring ODH to enforce the law. By July 2009, 41 agencies had opted out, leaving enforcement in 24 of Ohio''s 88 counties to ODH.⁹ Further rule changes allowed agencies to keep 90% of the paid fines to cover enforcement costs. Additionally, administrative hearings for violators were assumed by state offices.Nonetheless, the actual cost of enforcement, which varies by jurisdiction, is unknown but continues to drive PH agencies to opt out, thereby increasing the burden on ODH.¹⁰ Beyond costs, how an agency enforces ordinances can vary depending on the clarity of legislation and associated rules, professional training and expertise, differing views on prioritization and risk, differences in levels of authority, ineffective strategies, political pressures, population size served, and available staff and time for enforcement.^11–14 Prioritization and enforcement practices may be greatly influenced by decreasing funding and increased public expectation.¹⁵ Moreover, little was known about how these factors influenced PH practice of SFWPL enforcement across Ohio''s 88 counties and whether variation in practice is associated with agency characteristics. Knowledge about these variations may provide best practices for agencies to follow or areas in need of action.Therefore, we used qualitative and quantitative direct assessment of the PH workforce to provide information on the barriers, incentives, practice patterns, fiscal pressures, and opinions on SFWPL enforcement. Furthermore, we examined whether the agency census designations, as rural or urban, and supervisory levels, as administration or direct enforcement staff, may be associated with differences in PH practice and opinions regarding SFWPL.     

营口市食品卫生行政执法文书制作情况调查

[目的]了解营口市2002年和2004年10种食品卫生行政执法文书的规范化制作情况及存在问题的原因.[方法]从监督所档案室随机抽取两个年度的相同10种文书分别为449份和387份,按照各种文书规范化制作的标准和要求分别计算出各种文书的合格率及年度的平均合格率.[结果]2002年度和2004年度10种文书规范化制作的平均合格率分别为59.47%和90.63%.[结论]2002年度和2004年度我所10种文书在规范化制作方面都不同程度存在问题,但2004年度文书规范化制作的平均合格率较2002年度有明显提高.     

2005-2007年安阳市公共场所卫生行政执法案例分析

[目的]为了解安阳市公共场所卫生行政执法情况。为进一步规范卫生行政执法行为提供管理对策。[方法]依据《公共场所卫生管理条例》、《中华人民共和国行政处罚法》、《卫生行政执法文书规范》有关规定,对安阳市2005～2007年216起公共场所卫生行政执法案例进行分析。[结果]2005～2007年共发生公共场所卫生行政执法案例216起,216起案例中证据收集、文书书写、适用程序全部正确的131起,占60．6％;不合格案例主要原因有执法文书书写不规范、执法文书使用不当、执法程序错误、证据不充分、引用法规条款不当、处罚不当等。216起案例中,旅店业31起,理发美容业102起,公共浴室22起,游泳场所27起,商场书店25起,其他公共场所行业9起。[结论]2005年以来我市公共场所卫生行政执法工作还不够规范,应进一步提高卫生监督人员的综合素质,提高办案质量,公共场所卫生行政执法过程中适合用当场行政处罚。     

血吸虫病预防控制中的卫生执法监督

血吸虫病是一种严重危害流行区人民身体健康和生命安全、阻碍经济发展和社会进步的重大传染病[1],在我国南方尤其是长江流域血吸虫病仍然是严重威胁人民健康和阻碍社会经济发展的重大公共卫生问题[2].现将血吸虫病防控中卫生执法监督工作简述如下.     

Making the Case for Laws That Improve Health: A Framework for Public Health Law Research

Context: Public health law has received considerable attention in recent years and has become an essential field in public health. Public health law research, however, has received less attention.Methods: Expert commentary.Findings: This article explores public health law research, defined as the scientific study of the relation of law and legal practices to population health. The article offers a logic model of public health law research and a typology of approaches to studying the effects of law on public health. Research on the content and prevalence of public health laws, processes of adopting and implementing laws, and the extent to which and mechanisms through which law affects health outcomes can use methods drawn from epidemiology, economics, sociology, and other disciplines. The maturation of public health law research as a field depends on methodological rigor, adequate research funding, access to appropriate data sources, and policymakers’ use of research findings.Conclusions: Public health law research is a young field but holds great promise for supporting evidence-based policymaking that will improve population health.     

提高卫生监督人员执法水平的对策探讨

为提高卫生监督人员执法水平,适应卫生监督体制改革要求。文章从法规的建设,卫生监督人员自身存在的问题及执法水平评价体系等几个方面分析了制约卫生监督人员提高执法水平的主要因素,提出了加强卫生监督立法,完善制度化建设,对卫生监督人员进行素质教育,培养综合能力,建立执法水平评价指标,加大卫生法规宣传力度及实行行政监督、舆论监督和社会监督制度等七项对策。