Board of Health

Meeting Minutes
March 11, 2008

12:00 Noon
Rice Conference Room

Present:	Dr. Francis Fox; Mr. Brooke Greenhouse (12:17 PM); Dr. James Macmillan; Mr. Frank Proto (12:36 PM) Dr. Jeffrey Snedeker, President (12:13 PM); Mr. Greg Stevenson; and Dr. William Tyler
Staff:	Mrs. Sylvia Allinger, Director of CSCN; Mrs. Liz Cameron, Director of Environmental Health; Mrs. Sigrid Connors, Director of Patient Services; Mrs. Brenda Grinnell Crosby, Public Health Administrator; Jonathan Wood, County Attorney; and Mrs. Patty Stamm, Administrative Assistant
Excused:	Mrs. Alice Cole, Public Health Director and Dr. William Klepack, Medical Director
Guests:	Steven Kern, Sr. Public Health Sanitarian, Rick Ewald, Sr. Public Health Sanitarian; Stephen Maybee, Public Health Engineer; WIC Staff including: Jami Breedlove, Sr. Clerk; Amy Frith, WIC Program Director, Anne James, Nutritionist, Pat Jebbett, Nutrition Educator, Lucinda Mallery, Nutritionist; and Andrea Smith, Nutritionist; and Meredith Titterington, IC Student Intern

 

Dr. Snedeker called the regular meeting of the Board of Health to order at 12:13 P.M.

Mrs. Grinnell Crosby introduced Meredith Titterington, who is an Ithaca College Student Intern working with Mrs. Cole this semester. Meredith is working towards a degree in Community Health Education.

Approval of Minutes:

Dr. Tyler moved to accept the minutes of the February 12, 2008 meeting as written, seconded by Dr. Fox, and carried by a unanimous voice vote.

Upon arriving Mr. Greenhouse apologized for his tardiness and requested an edit be made to the minutes. On Page 3 under the Environmental Health Report, 3rd bullet, 1st sentence: strike “of Cornell University” so that it reads: “Mrs. Cameron distributed a report she received from Robert Howarth, Ph.D.” Mr. Greenhouse added he didn’t feel the letter was sent on behalf of Cornell University or in any capacity relating to Cornell University, however he felt the minutes implied the University had some interest in this matter.

This amendment was agreeable to both Dr. Tyler and Dr. Fox. Carried by a unanimous voice vote.

Financial Summary:

Mrs. Grinnell Crosby distributed a Supplemental 2007 Financial Summary stating, other than a couple of small edits they are working to resolve with the Finance Director, this financial summary is fairly accurate. She reviewed the summary line by line, pointing out areas where revenues are still coming in, as well as areas of deficit. She added overall the Health Department accounts globally are in good shape, with the exception of the CSCN mandates. Mrs. Grinnell Crosby stated the report showing surplus/deficits would likely not come out until sometime in April.

Administration Report:

In Mrs. Cole’s absence, Mrs. Crosby stated that there was no Public Health Director’s Report this month.

Medical Director’s Report:

Since Dr. Klepack was excused from today’s meeting, there was no additional report.

Division for Community Health:

In addition to her written report, Mrs. Connors reported:

• Six of the eight WIC staff are present today in reference to the recommendation to discontinue sponsorship of the WIC Program.
• Kim Hamilton has been hired as a new Team Leader. This is a promotional appointment and will help for a smooth transition. Mrs. Connors stated they would be seeking approval to hire a nurse for the vacant Community Health Nurse position as of Wednesday, March 12th.
• Edmund Tadros has been hired to work in the Community Health Services position and started on Monday, March 10th.
• Home Health Care had a record 67 patients admitted in January; 58 patients were admitted in February; and as of March 10th, 15 patients have been admitted. Since January 1st, 214 people have been served. The current caseload runs between 100-120 clients. In conversation with VNS, their caseload is currently running at about 20-25 clients. They continue to accept limited referrals. Mrs. Connors stated she didn’t anticipate VNS will be up to full speed for some time because they need to hire new staff who will need to be trained and this will take time.

Children with Special Care Needs:

Mrs. Allinger stated she had nothing to add to her written report.

County Attorney’s Report:

Mr. Wood reported that Bolton Point paid the County $14,650 in public water system fees.

Environmental Health Report:

In addition to her written report, Mrs. Cameron reported:

• Shady Grove Mobile Home Park has a new operator. They are under an enforcement action by the Health Department and are coming into compliance as they switch owners.
• Two other local mobile home parks are also changing owners and have what appears to be very good operators.

Resolution: Recommendation to Discontinue Sponsorship of WIC Program:

Mrs. Grinnell Crosby announced this agenda item would not be taken up in Executive Session at this time. Copies of the resolution were distributed to the WIC staff present at the meeting. Mrs. Grinnell Crosby added that this resolution is based on discussions previously held in Executive Sessions. Mr. Greenhouse moved to accept the resolution as written, seconded by Mr. Stevenson.

Dr. Amy Frith, WIC Program Director, addressed the Board on behalf of the WIC staff. She stated the Tompkins County Health Department has sponsored the WIC Program for 28 years, adding the WIC Program has been able to deliver quality services through its partnership with the Health Department for the following reasons:

• Being associated with the Health Department has allowed WIC to be able to execute its functions, which are preventive public health care and serving the needs of the clients of Tompkins County by providing nutrition services.
• Being associated with the Health Department has benefited the WIC clients through the administrative support necessary to run the WIC Program.
• The WIC Program has been able to serve its clients as a result of being able to retain dedicated staff for long tenures, thus being able to maintain the program’s quality of services.

Mrs. Connors reported as directed she would route around the Annual Report from the Tompkins Community Action Program which gives a little bit of information about the program seeking sponsorship of the WIC Program. A copy of this report has also been given to the WIC Program Director.

Mr. Greenhouse stated, with permission of BOH members, the record should reflect that this resolution in no way, shape, or form reflects any displeasure or anything less than their extreme satisfaction with the performance of staff. He added this is not in any way, shape, or form a reflection on anything Board members have been led to believe or conclude that there has been anything less than a terrific staff working very hard at the WIC Program. This is a decision based on other factors. He added that Board members really appreciate the hard work of the entire WIC staff and they hope that no one construes otherwise but that Board members really appreciate staff’s dedication and hard work.

Following questions regarding sponsorship of the WIC Program, Mrs. Connors stated the Health Department does not have the ability to determine who becomes the sponsor for the WIC program; that is totally a State decision. She stated at this time she knows Tompkins Community Action (TCA) has actively sought information and sponsorship, however added TCA will have to put information forth to the State regarding how their program is run in order to gain the sponsorship award. She added TCA has not been awarded sponsorship at this time; it could be another organization in Tompkins County, or contiguous County organizations.

Dr. Snedeker asked Dr. Amy Frith to comment more specifically on what aspects of the WIC Program she feels would be impaired by the loss of County sponsorship.

Dr. Frith commented she has not been the WIC Program Director for a long period of time, however she felt that there would be a disruption in services at a time when people were really seeking out WIC services. She added that WIC’s caseload is increasing every month. Dr. Frith stated if they changed organizations, there could be staff turnover, which would put a lot of pressure on delivering public services. She also stated she was unsure of what the capabilities of another entity would be in terms of administration support for the program, adding this is very important in running an organization. Another concern is the issue of local representation given the possibility that an organization outside of Tompkins County could end up being the sponsoring organization.

Mrs. Connors pointed out the Request for Application (RFA) of sponsorship for the WIC Program has been delayed by the State. The State does anticipate that the RFA will go out in a couple of months. Until the time the RFA comes out, no one can apply for sponsorship. Mrs. Connors stated because the RFA is delayed, it would most likely delay sponsorship being awarded as of October 1, 2008. She added it is possible that the State will come to the Health Department asking them to extend the current contract a month or a few months, or more.

Mr. Proto invited WIC staff to attend the next Health and Human Services Committee meeting on April 2nd at 3:00 PM, the Government Operations meeting on April 11th, at 2:00 PM, and/or Budget and Capital meeting on April 14th at 3:30 PM, where this issue will be discussed. He added this issue would go before the full Legislature on April 15th at 5:30 PM. If anyone is interested in attending any or all of these meetings, contact Mrs. Grinnell Crosby and she can let you know when this issue is scheduled on the agenda.

Correction of one term on the Board of Health:

Mrs. Grinnell Crosby announced that an error was noted on the listing of the Board of Health member’s terms. A correction needs to be made to Mr. Stevenson’s term to end on 12/31/13 instead of 12/31/11.

Mr. Greenhouse moved that Mr. Stevenson’s term be corrected to end on 12/31/13, seconded by Dr. Macmillan, and carried by a unanimous voice vote.

Potential Candidates for Board of Health Vacancy:

Mrs. Grinnell Crosby stated an application for membership on the Board of Health has been received from Sonja Seamon, Secretary to the Tompkins County Restaurant and Tavern Association. She added Ms. Seamon also indicated she would list the Board of Health vacancy in the March newsletter for the Restaurant and Tavern Association. This means there may be additional applications coming forward if Board members would like to defer approval of a candidate at this time.

After a short discussion among Board members, it was decided even though it is important to fill the vacant seat as soon as possible, the opportunity to receive additional applications should not be foregone. A letter will be sent to Ms. Seamon thanking her for publishing the Board of Health vacancy in the newsletter, and also advising her that applications need to be received no later than April 7th so that they can be brought forth at the April 8th Board of Health meeting.

Approval for revision to: Human Papillomavirus (HPV) Vaccine Policy:

Dr. Tyler moved to accept the revision to the policy as written, seconded by Dr. Macmillan, and carried by a unanimous voice vote.

Approval for revision to: Lead Poisoning Prevention Program – Quality Improvement (QI) Policy & Procedure:

Mrs. Connors reported all of the recommended revisions were submitted to the State and received its approval, so the revisions are now coming before the BOH for its approval.

Mr. Greenhouse moved to accept the policy as revised, seconded by Mr. Stevenson.

Mr. Greenhouse asked for clarification to item #5 under section A. Review of Lead records. Mrs. Connors explained that blood lead lab results are screened daily and suggested changing the word “prescreened” to screened.

Approval for revisions, as amended, carried unanimously.

Approval for revision to: Lead Poisoning Prevention Program – Blood Lead Testing Procedure:

Mrs. Connors reported all of the recommended revisions were submitted to the State and received its approval, so the revisions are now coming before the BOH for its approval.

Mr. Greenhouse moved to accept the policy as revised, seconded by Mr. Stevenson.

Dr. Snedeker made the recommendation under Section 2, items d) and e), specific individuals’ names not be referred to, but rather their positions. Mrs. Connors stated that this was an oversight, that Dr. Klepack and Carol Mohler’s names should have had a line drawn through them. Item d) will read: Requested by MD, add Medical Director, and item e) will read: “TCHD”, add Team Leader.

Approval for revisions, as amended, carried unanimously.

Review of the Procedure/Policy for Article IX, Air Pollution Control (Not Open Burning):

Mrs. Cameron explained they receive complaints on Section 9.01 of Article IX, Air Pollution Control. Air pollution can be smoke, odors, or dust from any source; the main sources in Tompkins County being indoor fireplaces and woodstoves and outdoor furnaces and recreational fires. She added the most difficult cases are the ones that affect one person. This would refer to §9.01 of Article IX, part b., item #2): Injury to or endanger the health and safety of any person, or… Mrs. Cameron stated it could be difficult for staff to witness a violation affecting one person involving the types of incidents previously mentioned. This is the normal procedure for bringing a complaint to the Board of Health. She stated her Division would like to have a procedure/policy in place whereby an individual can bring a complaint to the Board when Environmental Health staff is unable to witness the violation. She asked for input from the Board regarding the Draft Procedure/Policy and what specific information or evidence would be sufficient for an individual to bring a complaint to the Board.

Mr. Greenhouse thanked Environmental Health staff for taking the time to put this Draft Procedure/Policy together, however he expressed concern over the item #3, feeling that it could be a potential for making a bad situation even worse. Dr. Snedeker suggested that item #3 be stricken from the policy, adding the intent is covered in item #1. The initial complaint is investigated and, when appropriate, feedback is provided to the potential source. He added in doing that EH has discharged its responsibility to notify, to educate, and by that very action the person will then be aware that there are issues. Dr. Snedeker suggested item #1 could be expanded so if it was not appropriate for EH staff to notify the complainant, it would not be obligatory in each case. Mr. Greenhouse also questioned what the threshold for a violation was in item #2. It was also suggested that in item #4, the first sentence be changed to read as follows: “Complaints regarding sources from facilities with a permit from the DEC to discharge air contaminants must first be referred to the DEC.” In item #8, first sentence should read as follows, “If a violation of 9.01. is found, the Board of Health can order abatement.”

Following a lengthy discussion between Board members and staff, additional thoughts, points, concerns, and suggestions were brought forth:

• Have guidelines rather than a policy
• Not the job of staff to look at evidence and determine if someone should be cited for a violation
• Burdensome on staff – no set procedure - how can situations be minimized when there is no way to resolve them?
• Suggest Community Dispute Resolution Center
• Main problem with section §-9.01, Item b. 2) - showing injury to or endangering the health and safety of any person – these are often people claiming to have a preexisting medical condition and that is why they are aggravated by something that might not be injurious to someone else – can not show cause and effect – a violation that can not be proven
• Looking for some kind of standardizing of what would be evidence if violation taken to a hearing
• Limited equipment to test for air contaminants – not a lab
• Individuals with chronic lung problems and very sensitive to environmental pollutants, etc. need some form of recourse; if it isn’t Article IX, then there needs to be other mechanisms for these individuals to address concerns – if there is no other recourse, then Section IX needs to stay
• Some violations may occur very late in the evening/very early in the morning, during which time air pollution control cannot be enforced - staff cannot go out in the middle of the night to investigate complaints
• Public health has to be something that affects other people and if there are other people in the area, they are affected as well – when referring to one person who is affected while there are other people in the area, it does not fall into the area of public health – this gives good cause to delete #2 under item b. of §-9.01. General Provisions
• Article IX needs to be “tweaked”

Mr. Greenhouse made the suggestion that the abolishment or the revision of Section §-9.01. in the Tompkins County Sanitary Code be considered.

Dr. Snedeker, on behalf of Board members, requested that EH staff make recommendations on how Article IX can be improved or eliminated. If improved, what policy will go hand-in-hand with that to make it functional? In the interim, staff will develop their own guidelines in handling complaints they receive. It was recommended that items #3, #6, and #7 be stricken from the Draft Procedure/Policy and that document be used as a guideline at the discretion of EH staff.

Happy Birthday:

Mrs. Grinnell Crosby presented Dr. Fox with a birthday card and Board members all wished him a very Happy Birthday!

Adjournment:

Dr. Snedeker adjourned the meeting at 1:47 P.M.