Board of Health

Meeting Minutes
May 13, 2008

12:00 Noon
Rice Conference Room

Present:	Dr. Francis Fox; Mr. Brooke Greenhouse; Dr. James Macmillan; Mr. Frank Proto; Dr. Jeffrey Snedeker, President (12:10 PM); Mr. Greg Stevenson; and Dr. William Tyler
Staff:	Mrs. Liz Cameron, Director of Environmental Health; Mrs. Alice Cole, Public Health Director 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:	Dr. William Klepack, Medical Director
Absent:	Mrs. Sylvia Allinger, Director of CSCN
Guests:	Steven Kern, Sr. Public Health Sanitarian, Rick Ewald, Sr. Public Health Sanitarian; John Andersson, Private Engineer; and Rich Moravec, Director, Empire State Well Drillers Association

 

Due to the heavy agenda, Mr. Proto called the regular meeting of the Board of Health to order at 12:06 P.M. Dr. Snedeker arrived shortly afterwards and took over as Chair of the meeting.

Mrs. Cole requested an addition to the Administration Agenda Items: Authorization to Submit Certificate of Need (CON) Application for 55 Brown Road – Health Department.

Approval of Minutes:

Mr. Greenhouse moved to accept the minutes of the March 11, 2008 meeting as written, seconded by Dr. Tyler, and carried by a unanimous voice vote.

Financial Summary:

Mrs. Grinnell Crosby distributed the April 2008 Financial Summary. She reported the 1st Quarter State Aid Claim for $435,508 has been filed. She added this amount has not been reflected as a revenue yet; it will be reflected when it gets paid. Currently, they are dealing with auditing issues. Mrs. Grinnell Crosby stated salaries appear high, adding they have not received the budget adjustment from the County yet that takes care of authorized raises for management and white collar. Once this is taken care of, salaries will be more on target. She added revenues are doing well in Vital Records and the Home Care revenues are exceeding the projected period of the year, which is very good.

Administration Report:

Mrs. Cole distributed:

• a report from Tom Okoniewski, BCEHFP Field Coordinator from the NYSDOH Central New York Regional Office, regarding his review of the 2007 year-end Performance Measures Report for the Environmental Health Division;
• information on Hookah bars (Mrs. Cole received information that it is rumored an individual is considering putting a Hookah bar in Tompkins County which would require a waiver to come before the Board of Health). Note: New Hookah bars are not permitted in Tompkins County;
• a packet of applications received for the vacancy on the Board of Health;
• the flu report, adding that the flu is now down to sporadic levels;
• an enumeration from the State Health Department of the local public health workforce, going down to the County level. She added there are many interesting things regarding Tompkins County and its workforce.

Mrs. Cole reported:

• BOH agendas and minutes will now be posted on the Health Department website. Mrs. Cole also stated a short biography of each Board member would also be posted on the website. She passed around a sample bio for Board members’ edits or approval.

Medical Director’s Report:

Since Dr. Klepack was excused from the meeting, there was no addition to his written report which was distributed at today’s meeting.

Division for Community Health:

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

• An edit needed to be made to the April and May Summary of Disease Reports which is included in the Director of Patient Services Report. Under “Sexually Transmitted Diseases” – Chancroid shows 19 cases for February; this number should be 0 and the 19 cases should be listed under Chlamydial Infections. The 2008 Yr. Totals should also be changed to reflect this number reversal.
• Last year there were a total of six reported cases of Syphilis; as of today, six cases of Syphilis have been reported for this year. Mrs. Connors added during the winter a special work group was formed including staff from Cornell University, Gannett Center; Ithaca College, Hammond Center; Planned Parenthood; TC3; and the Health Department. These individuals have been working together to see what could be done in terms of education and outreach to address the increase in Syphilis cases. Mrs. Connors also stated the Health Department’s STD site has had a lot of material and linkages added to it. In addition, mini posters have been created, two of which Mrs. Connors passed around – one is for provider offices and the other is for the community; also, a website has been established called getyourpeaceofmind.com which is a shared website amongst the partners.
• An e-mail is received on a weekly basis from the Visiting Nurse Service (VNS) regarding their status. In the beginning of last week, they were able to receive clients; on Thursday they had to stop and would be able to take them again as of Monday of this week. However, on Monday, VNS said they had too many clients and would not be able to take any additional clients until next week. Mrs. Connors stated Home Care staff is working very hard to keep up with the additional caseload and they continue to use the per diem staff on workdays to help fill the gaps.
• Mrs. Connors stated she is about to place an ad for a nurse for the Home Care team due to an impending retirement.
• The State Health Department completed a survey of the Health Department STD Program. Seven of their staff, including a CDC consultant, came to meet with Health Department staff for the better part of two days looking at contracts, financial data, policies and procedures, made visits to Gannett Health Center and Ley Lab; looked at Cayuga Medical Center labs; and Planned Parenthood. They stated the Health Department is doing a great job and they think very highly of the program. A written report will follow in six to eight weeks.

Children with Special Care Needs:

Since Mrs. Allinger was absent from today’s meeting, there was no additional report.

County Attorney’s Report:

Mr. Wood reported the County closed on the 55 Brown Road building, now making it a County building.

Environmental Health Report:

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

• The Environmental Health Division was asked to review Article IX of the Tompkins County Sanitary Code, Air Pollution. She added she wanted to notify the Board that when this is done they would prefer to review some of the other key sections as well, i.e. the food section of the code is outdated, as well as other areas that should be updated. Mrs. Cameron added there will be just one hearing.
• In the Environmental Health Highlights, there used to be a section on stray cats that has been deleted. Mrs. Cameron stated the numbers never made any sense to her and unless there is any objection, she plans to leave it out of the Highlights report.
• Prior to the scheduled April BOH meeting, there was a meeting with Cayuga County; Jonathan Wood; and Health Department staff to discuss the Owasco Lake Watershed rules and regulations that are anticipated will apply in Tompkins County. Cayuga County will be sending a letter clarifying regulations which, when agreed upon, will then be brought before the Board of Health. The Board will be responsible for any enforcement actions resulting from these regulations.

Potential Candidates for Board of Health Vacancy:

Prior to the start of the meeting, Mrs. Cole distributed packets containing applications from four candidates for the vacant seat on the Board of Health.

Following a short discussion amongst Board members, Mr. Stevenson nominated Michael J. McLaughlin, Jr. to fill the vacant seat on the Board of Health. This was seconded by Mr. Proto, and carried by a unanimous voice vote.

Mrs. Cole will send letters to the other three candidates thanking them for their interest and then will keep their applications on file for future reference.

Approval of Resolution: Authorization to submit Certificate of Need application for 55 Brown Road – Health Department:

Mrs. Cole stated the Health Department as a home care agency and clinic is required to file a Certificate of Need with the State Health Department before any renovations can be made to the Brown Road facility. She added they have hired their accountant to assist with this lengthy process due to the large amount of paperwork that needs to be completed and submitted to the State for approval, primarily for the home care and diagnostic and treatment center areas.

Mrs. Grinnell Crosby stated that an edit/addition needed to be made to the resolution: Under “RESOLVED,” it should now read: RESOLVED, on recommendation of the Tompkins County Board of Health, the Health and Human Services, Facility and Infrastructure Committees, …

Mr. Greenhouse moved to approve the resolution as amended, seconded by Mr. Proto, and carried by a unanimous voice vote.

Approval of Resolution: Authorization to submit Certificate of Need application to add Medical Social Services to CHHA Operating Certificate:

Mr. Greenhouse moved to accept the resolution as written, seconded by Dr. Tyler, and carried by a unanimous voice vote.

Approval of revisions to the Employee Hepatitis B Vaccination Procedure:

Mr. Greenhouse moved to approve the revisions to the policy as written, seconded by Mr. Stevenson.

Following a lengthy discussion regarding Section IV. “Serology,” Mr. Greenhouse pointed out that in Appendix A, under the Sheriff’s Department (Road Patrol), Joe Vitale was listed as the contact person. Mr. Vitale is now retired, so Mrs. Connors will contact Sheriff Meskill to see who will replace Mr. Vitale as the contact person for the Road Patrol.

The revisions to the policy, as amended, were carried by a unanimous voice vote.

Approval of revisions to the Bloodborne Pathogen (BBP) Education and Hepatitis B Vaccination for Employees in At-Risk Positions:

Mr. Greenhouse moved to accept the revisions to the policy as written, seconded by Dr. Macmillan.

On Page 2, Section E “Record Keeping – Vaccination.” #5., Mr. Greenhouse questioned if it should read “medical records” or should be changed to “HIPPA records.” Mrs. Connors stated she would replace this sentence with the one used in the previous policy under III. “Clinical Services,” C. Records, #4, so it will now read: “All employee records will be handled confidentially using HIPPA standards for Protected Health Information.”

The revisions to the policy, as amended, were carried by a unanimous voice vote.

Approval of revisions to the Bloodborne Pathogen (BBP) Post Exposure Plan:

Mr. Greenhouse moved to accept the revisions to the policy as written, seconded by Dr. Macmillan.

Following a lively discussion during which Board members reviewed several sections of the policy and recommended several small edits, Mrs. Connors, DPS, stated she would follow up on all recommendations and make edits as requested.

The revisions to the policy, as amended, were carried by a unanimous voice vote.

Approval of New Policy: Facilities Division – Bloodborne Pathogen (BBP) Policies & Procedures:

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

Proposed revision to Tompkins County Sanitary Code, Article VII – Water Supply: discussion and vote:

Mrs. Cameron stated the Division of Environmental Health is proposing revisions to Article VII of the Tompkins County Sanitary Code (TCSC), currently called “Water Supply,” proposed title – “Drinking Water Systems.” She stated these proposed changes would establish a program for permitting water wells and added there are also changes in the proposed code for small water systems.

Packets were distributed to Board members 10 days prior to the Board of Health meeting which included:

• Summary Report of Hearing Officer, Brook Greenhouse, prepared April 22, 2008
• Notes on Article VII Public Hearing, February 11, 2008 prepared by Mrs. Cameron
• Proposed Revisions – summary and discussion, April 27, 2008, prepared by Mrs. Cameron
• Proposed Revised Code
• Proposed Revised Code noting changes made after the Public Hearing.

Highlights of a lengthy, but lively discussion were:

• Mrs. Cameron stated one of the issues brought up in the Hearing Officer’s report was whether the Tompkins County Health Department has the authority to enforce this section of the code without implementing its own regulations. Mrs. Cameron stated the State adopted well construction standards that are contained in Appendix 5B of their code. This is referenced in the NYS Residential Code, which is enforced by the Code Enforcement Officers. This means that the Code Enforcement Officers have the authority to enforce these standards, unless TCHD adopts its own code or unless TCHD requests to have it included under the State Aid Application/MHSP. The Health Department is required to provide technical assistance, which is currently being done, for individual water wells, and TCHD would also be required to issue any specific waivers that are allowed under Appendix 5B. Mrs. Cameron discussed the benefits of the proposed Water Well Permitting Program including:
·
• Water/Sewage System Coordination
• Help Retain Current Lot Size Requirements
• Water Well Data Repository
• Provide Training and Expertise.
• Mr. Greenhouse stated that originally he had a longer Hearing Officer Summary Report, but he amended this report due to:
1. Guidance provided to him after his original report that seemed to suggest some of the information provided in his original report was beyond the scope of a Hearing Officer’s obligations. (Mr. Greenhouse suggested in the future it would be extremely important for formal guidance regarding responsibility to be provided to a Hearing Officer.)
2. It was Mr. Greenhouse’s understanding that as a Hearing Officer he was to provide Board members not with his own opinion, but with a good reflection and some level of conclusion of what actually happened at the meeting. After discussion with staff, Mr. Greenhouse felt there was an additional conclusion that he drew that might not have been accurate, so rather than to mislead everyone, he withdrew that statement from the report.
• Regarding the authority to enforce the regulations currently in place, Mr. Andersson, speaking as a member of the public, stated his understanding was the Health Department has the authority to enforce NYSDOH regulations, but has no authority to issue a permit. Mrs. Cameron added the Health Department cannot have its own permitting program without adopting its own code, referencing Appendix 5B.
• For the benefit of Board members, Mr. Greenhouse explained the ultimate power held over a home owner in most cases is preventing the issuance of a Certificate of Occupancy which is issued by the Building Department. If a home owner does not obtain a Certificate of Occupancy, they cannot legally move into their home.
• Mr. Rich Moravec, Director of the Empire State Water Well Association, expressed his feeling that there was not a need for the residential aspect of the proposed revisions to Article VII. However, he added he felt the public water aspect of the proposed revisions should go forward.
• Mr. Greenhouse read a letter from the Randolph Well & Pump Co., Inc., Ray L. Converse, CWD, PI, President, and Lawrence R. Converse, CWD, Secretary. They expressed their opinions against the revisions to Article VII, stating if existing regulations are already in place for septic permits and are not being practiced by a select few people, how will adding another permit such as a well construction permit stop this from happening. They added their company feels if NYSDEC, or at the County level, enforced these existing regulations and was making sure all water well drillers are NYS licensed this would not even be an issue. (copy of letter attached)
• Mr. Andersson, former Director of Environmental Health, spoke to the Board in favor of the Well Permitting Program. He stated having a permit for a well is proactive like the Sewage System Program. The Health Department is responsible now for dealing with problems after they arise. A permit program would give Environmental Health the opportunity to deal with problems before they come up. He added this is an important part of the program. Secondly, it helps to protect the acre lot size. Mr. Andersson stated a lot of other counties are moving towards increasing the minimum lot size where private water and private sewage is required because of the separation distances required under Appendix 5B. He added if you have the authority to issue a permit for the well and the sewage system at the same time you can issue it with the broader picture in mind about what’s going on in the neighborhood and protect the neighboring lot that hasn’t been developed. Lastly, Mr. Andersson stated, as problems come up, the Health Department is left to solve them after the fact. He added a permitting program would give the Health Department a chance to adjust those problems beforehand.
• Mrs. Cameron stated items can be removed from the proposed code and then adopt it, i.e. the requirements could be removed from the individual water program and adopt the remaining code without going through the hearing process again. If the proposed code is not adopted, then they continue on as they currently are unless they decide to put resources that are tight into other areas such as education or training. Mrs. Cole pointed out resources that were allotted in the 2008 budget will no longer be there. Mrs. Cameron stated the Well Permitting Program is currently funded with a half-time position, so those resources would be lost.
• Mr. Greenhouse applauded the department’s efforts to help make things work for residents. He added that, personally, he did not see how this program can sustain itself. He felt a better choice for the immediate future would be when someone has a really challenging site or when they have created their own problem, let them figure it out. He added the well drillers are obligated as part of their registration to comply with the law. If they don’t comply with separation distances, then someone should push the DEC to go after the well driller and take away their registration so they would not be allowed to drill.
• Mr. Andersson commented he felt Mr. Greenhouse was opposed to the permit program. He added he felt Mr. Greenhouse was a poor choice for the Hearing Officer due to a conflict of interest. He stated he felt hearing officers should be neutral in hearing arguments and reporting their findings and recommendations.
• Mr. Greenhouse responded “as a Board member,” based on his expertise with two decades of experience in the construction industry. He stated every effort he made as a Hearing Officer was to be completely neutral to the best of his abilities. He stated he took “tremendous umbrage” with any suggestion he attended the hearing with any intention or any efforts to be anything other than objective and neutral. He added he was confident if anyone reads his Hearing Officer’s Report, it does reach a conclusion that is clearly reflective of the information presented at the hearing. Mr. Greenhouse further stated he was concerned about the regulations and shared these concerns today as a Board member, not as a Hearing Officer. He added besides “being offended,” he felt that it was “patently ridiculous.”
• Dr. Tyler pointed out an edit that should be made on Page 4 of 6, S-7.05 Other Regulations, (b.) that Mrs. Cameron will correct. He also commented he did not feel he had enough knowledge to vote intelligently on this issue at this time, so would abstain from the vote.

Dr. Snedeker made the suggestion the discussion be continued at the June meeting, adding the critical question is the necessity of an additional permitting program/process. Mr. Proto added as an individual he had no reason to doubt Mr. Greenhouse was absolutely objective in this matter.

Mr. Greenhouse commented as “Hearing Officer” he would like to remind everyone of one very clear conclusion he noted which was there really were no comments about the public water program, for or against. As a “Board member,” Mr. Greenhouse stated he did not completely understand the public water system since it was not in his realm of professional expertise, however he added he was convinced by the information provided by staff that this needed attention. He added if it was not too complicated to separate the two issues and if not too onerous, he would very much support moving forward with the provisions related to the public water systems since there is no contention about those things. He also added staff has made it very clear there seems to be a need for that. Mr. Greenhouse also stated he felt the needs of the public water system should not be compromised because of their concerns related to the private water systems.

At Dr. Snedeker’s request, Mrs. Cameron stated she would separate the two water programs so that Board members could review them on an individual basis. Discussion to continue at next month’s meeting.

Pinecreek Campground, Richard Holgate, Owner – Revision of BOH Orders:

Mr. Greenhouse moved to accept the resolution as written, seconded by Dr. Macmillan, and carried by a unanimous voice vote.

Rogan’s Corner, Jim Reynolds, Operator – ATUPA Violation:

Mr. Greenhouse moved to accept the resolution as written, seconded by Dr. Macmillan, and carried by a unanimous voice vote.

Steven Mendelsohn, 411 Snyder Hill Road, (T) Dryden – Tompkins County Sanitary Code Violation – Sewage:

Mr. Greenhouse moved to accept the resolution as written, seconded by Dr. Macmillan, and carried by a unanimous voice vote.

Adjournment:

Dr. Snedeker adjourned the meeting at 2:10 P.M.