Board of Health

Meeting Minutes
July 8, 2008

12:00 Noon
Rice Conference Room

Present:	Dr. Francis Fox; Mr. Brooke Greenhouse (12:18 PM); Dr. James Macmillan; Mr. Michael McLaughlin, Jr.; Mr. Frank Proto; Dr. Jeffrey Snedeker, President (12:14 PM); Mr. Greg Stevenson; and Dr. William Tyler
Staff:	Mrs. Liz Cameron, Director of Environmental Health; Mrs. Sigrid Connors, Director of Patient Services; Mrs. Brenda Grinnell Crosby, Public Health Administrator; Dr. William Klepack, Medical Director; Jonathan Wood, County Attorney; and Mrs. Patty Stamm, Administrative Assistant
Excused:	Mrs. Sylvia Allinger, Director of CSCN and Mrs. Alice Cole, Public Health Director
Guests:	Steven Kern, Sr. Public Health Sanitarian

 

Since Dr. Snedeker was running late, Mr. Proto called the regular meeting of the Board of Health to order at 12:05 PM. Upon Dr. Snedeker’s arrival, he took charge of the meeting.

Mr. Proto announced that Item #1 on the Agenda under Administration (Approval to submit 2009 Draft Budget) would need to be addressed in Executive Session, so this item was moved to the bottom of the Agenda.

Approval of Minutes:

Mr. Stevenson moved to accept the minutes of the June 10, 2008 meeting as written, seconded by Dr. Macmillan, carried.

Financial Summary:

Mrs. Grinnell Crosby stated that there was no Financial Summary for this month. She added, due to a change by the County, they are sill trying to reconcile the books.

Administration Report:

In addition to Mrs. Cole’s written report included in the BOH packet, Mrs. Grinnell Crosby reported that the Certificate of Need documents for 55 Brown Road were sent Federal Express to the NYSDOH on Monday, July 7th. The next step will be to await comments and authorization on the project from the State.

Medical Director’s Report:

• Dr. Klepack commented briefly on an article from his written report on “Colorectal Cancer,” stating the basic message he was trying to get across was that looking at incident rates vs. death rates from cancers you can often see widely disparate rankings. He added a lot of this has to do with utility of detection methods and also advocacy of treatment. Dr. Klepack stated from a public health point of view, it’s important to focus on the things where an impact can be made, impairment and death rates by early detection for things that have a meaningful treatment.
• Dr. Klepack passed around the final letter regarding medication and syringe/needle disposal that was inadvertently omitted from his BOH report.
• Dr. Klepack further discussed another article from his BOH report on access to health care issues. He added he wrote a letter to the Ithaca Journal, which might be published in the near future, regarding the current Medicare bill in the Senate and Congress. He stated this bill could have a big impact on access to health care through Medicare for seniors.
• At Mr. Proto’s request, Dr. Klepack spoke a bit more about the decreasing number of physicians and the impact of physicians aging out, which he had addressed in his BOH report.

Division for Community Health:

Mrs. Connors reported:

• They have a very limited supply of rabies post-exposure vaccine. They are only able to obtain the vaccine from the vaccine company (Sanofi Pasteur) by submitting a certified copy of information stating who the vaccine is going to. She stated it is a very tight time frame – vaccine can only be ordered based on exact need. She added since this is peak season, they are ordering every week. Mrs. Connors also stated, per NYSDOH, they are not to give out any pre-exposure rabies vaccine since this is all being channeled into post-exposures.
• They had a short-term opportunity to apply for $15,000 from the State for Syphilis and STD outreach and education; she will summarize their application request in her August BOH report. She stated she anticipates hearing from the State regarding this grant request by next month. Mrs. Connors stated they would like to use this money for posters, flyers, brochures, and for development of a dedicated STD website that would have links to all of the community partners.
• Sadly, Mrs. Connors reported the resignation of the WIC Director. Amy Frith will be leaving July 26th to pursue an Associate Professorship of Nutrition role at Ithaca College. Mrs. Connors stated the WIC Program is currently doing well. The budget for WIC’s fiscal year, October 2008 through September 2009, has been submitted. In this budget an additional position has been requested that would be an intermediate level supervisor, Team Leader role or Senior Nutritionist. This senior position would help to bridge the gaps between new directors and help to take some of the load off Mrs. Connors, since when the Director is gone she is the Interim Director.

Children with Special Care Needs:

Mrs. Grinnell Crosby stated there was nothing to add to Mrs. Allinger’s written report.

County Attorney’s Report:

Mr. Wood stated he had nothing to report.

Environmental Health Report:

Mrs. Cameron reported:

• An update on a potential outbreak situation connected to a local wedding reception: no analytical results yet; however there does not appear to be any food related connection. She did state there may be a law suit from the family due to poor food quality, not related to the illnesses (approximately 20 guests). Wedding attendees were from all over the country, as well as local. Over 100 calls were placed to obtain information regarding this incident.
• NYS DEC is proposing amendments to their open burning regulations. One of the main differences is the DEC is proposing to prohibit burning of plastics in agricultural waste, which has not been done before. She stated the main issue is the economic impact; however they are trying to come up with recycling alternatives. She also stated there are specific issues related to plastics in agriculture – they are more contaminated with other materials that can complicate recycling. Mrs. Cameron stated the public comment period has been delayed until August 14th. She also added they would hold off revising Article IX of the Tompkins County Sanitary Code until they find out what is happening with the DEC regulations.
• At the June BOH meeting there was a discussion on the proposed fees for surface water systems (Cornell University, Ithaca College, and Bolton Point) and Board members requested a letter be sent to the three large water systems. Mrs. Cameron requested clarification on the contents of the letter – whether the letter is to inform them of the fee and the rational behind it, in which case she would tend to send it out after the fee has been adopted – or whether the letter is meant to go out now to solicit input. Dr. Snedeker stated he felt the letter was meant as a courtesy to inform the water systems of the expected change in fees so they could prepare for it. The Board also discussed the legal basis for BOH fees and potential efforts to change the law. The decision was made that once the fees have been adopted by the Board, a letter should be sent stating the Board has recommended the proposed fees, however it is still pending approval by the Legislature.
  • Mr. Wood explained that in the law it states that the local health department can charge a fee, but there is no guidance as to what an appropriate fee would be. He added this could be amended to specify what types of fees could be charged, i.e. per capita, by usage, etc. At Mr. Proto’s recommendation, Mr. Wood stated that the Board of Health could submit to or ask the State to change the law to include specific language, etc. He added this has never been done by the Board of Health, but it could be done; or the Board of Health could submit it to the County Legislature for their approval and subsequent submission to the State. Mr. Wood stated the general rule with fees, when there is no law setting forth how the fee is to be set, it is supposed to be related exactly to the service that is being provided to the person.
  • Following a brief discussion, Mr. Greenhouse made a motion to request that Mr. Wood’s office draft legislation for the Board of Health to consider allowing the Health Department to charge fees in a reasonable manner, at their discretion as a Board, including methods such as per capita application. This motion was seconded by Mr. Proto; carried unanimously.
  • Mr. Wood stated that he would bring back a resolution and a proposed law with changes. He stated there is a process that needs to be followed in making proposed changes to the law.
• Regarding the ongoing problem with the sewage system at Congers Mobile Home Park: they are installing a new sewage system with fill that was failing to perk. The DEC is the main authority for this system and they have given Congers MHP a deadline of July 11th to get the system installed or some sort of action will be taken. Mrs. Cameron stated a tank has been installed that is pumped to prevent sewage, which satisfies their BOH order.
• In the Environmental Health Highlights report there is a section called “SEQR” (State Environmental Quality Review) listing any action taken by the Division subject to SEQR. Mrs. Cameron stated that, unless there was any objection, she would like to remove this section from the Highlights. She said it could be reinserted if there was any outside objection to this action. She further stated she would be meeting with the Planning Department to get better clarification on SEQR and how things should be interpreted.

Approval of Professional Advisory Committee membership for Mrs. Ione Scanlon:

Dr. Tyler moved to approve Professional Advisory Committee membership for Mrs. Ione Scanlon, seconded by Dr. Macmillan, and carried by a unanimous voice vote.

Approval for revision to the Procedure: Catheter Management and Principles of Intravenous Therapy:

Mrs. Connors stated this procedure had been previously submitted to the Board for their approval, but was withdrawn due to questions regarding antibiotics. The procedure is being brought back before the Board with removal of any specific antibiotic reference purposely because they want this procedure to address any administration of an intravenous therapeutic medicine.

Dr. Tyler moved to approve the revised procedure as amended, seconded by Dr. Macmillan.

Following a short discussion the following amendments (typos) were offered to the above procedure revision:

Under “Procedure:”

• #7 - eliminate cross-out,
• #8 - substitute ‘must’ for ‘my’ in line one,
• #13 - substitute ‘occlusive’ for ‘collusive’ in line two,
• #21 - substitute ‘less’ for ‘leass’ in line three

Checklist Box:

• Last bullet, add space in line one,

Add:

• Revisions approved: PAC, 6/11/08 and BOH 7/8/08.

Motion carried unanimously.

Vote on Proposed Revision to Tompkins County Sanitary Code, Article VII – Water Supply:

Mrs. Cameron reviewed the packet summarizing revisions to the Sanitary Code, Article VII.

Mrs. Cameron stated that continuing development in Tompkins County will be on more difficult sites. She feels there will be more and more problems trying to site water wells and sewage systems on difficult lots. Mrs. Cameron stated she feels it makes sense to implement the coordinated water and sewer program through the Health Department, especially since her staff has the expertise, and are doing the sewage program. She added there are problems with the current program (“Water Supply”) being enforced through the NYS Residential Code and the Code Enforcement Officers (CEO’s).

Dr. Tyler spoke in favor of the proposed revisions to Article VII.

Dr. Tyler moved to approve revisions to the Tompkins County Sanitary Code, Article VII – Drinking Water Systems, Attachment A – Well Permitting Program Included, seconded by Dr. Macmillan.

A lively discussion ensued including comments on:

• Responses from CEO’s regarding enforcement of Appendix 5-B requirements.
• All five CEO’s who responded to the EH survey expressed support to the Health Department having an individual well program. (Surveys were sent to 10 CEO’s in municipalities with individual water.)
• The increasing amount of time over the past five years that EH staff has been devoting to the sewage program — the argument being that the absence of an integrated water and sewage program makes coordination of both systems more difficult, less efficient, and more time consuming, etc.
• Arguments from well diggers was that there was already a State Code in place to address these issues — does this mean that EH is not comfortable with those professionals enforcing the State Code? Response — The Health Department would like the well permitting program included in Article VII to allow them to enforce the system instead of CEO’s. They would take over the program thus there would be no duplication of effort.
• The Health Department has requested that well drillers voluntarily give a copy of the well logs directly to them due to lengthy wait time with their request to DEC. Compliance has been inconsistent.
• Sewage permits and the need for coordination with well drillers.
• Concern with well permitting program that is another cost added to previous expenses incurred with building a home, (proposed for 2009 – new system - $200 & replacement - $100).
• Question the hesitancy to approve a program with such a small percentage of overall cost of a very expensive investment which may save the home builder a lot of money.
• Delay vote for a couple of months and suggest sending a letter to CEO’s/well drillers informing them of what their true responsibilities are.
• The decision on this program will impact 2009 budget. At this point, the Well Permitting Program is in the budget in its entirety. If vote is delayed, guidance will be needed since this involves positions (½ time Sanitarian and ½ time Account Clerk Typist) and contractual expenditures, as well as $33,000 in revenue. If the Well Permitting Program is not going to be approved, additional funding can be recalculated and the over target requests to the Legislature can be reduced.
• CEO’s have been offered training classes as well as educational materials through the State Health Department; well drillers claim to be well educated through the Water Well Drillers Association, however non-compliance is seen in both. For the Health Department to put more effort into this would take resources away from another program.

Mr. Greenhouse stated that he had more questions specific to the program, but these could take some time to answer based on new information that was shared today. He added if there was a time constraint, he would move to table the motion. Failed for lack of a second. Mr. Greenhouse then moved forward with his questions pertaining to:

• Item #1: Pg. 3 of 6 – S-7.04 Water Well Certificate of Completion – item d. – second sentence should contain “CEO,” as well as “Registered Well Driller,” as automatically being allowed to perform inspections. The amended sentence would read: “The inspection may be performed by the Department and/or a Design Professional, a well driller, a CEO, or other person authorized by the Department…..”
• Item #1: Pg. 3 of 6 – S-7.04 Water Well Certificate of Completion – item c. – permit holder must ensure that a water sample must be analyzed. In the past, as well as today, it was discussed that the Health Department was taking water samples Mrs. Cameron stated some of the confusion is that this applies to wells other than individual wells. For individual home owners, the Health Department will go out and collect the samples (lab samples are part of the permit fee). If it’s another public water supply, they may collect the samples themselves,
• Water Well Certificate of Completion, and
• Future coordination of a middle property between two potential properties.

Following a lively discussion on the previous comments, Mr. Stevenson, who had a time constraint, stated he would make a motion to table this discussion if it needed to be continued.

Dr. Tyler moved to call the question: Carried unanimously.

Vote on the original motion with proposed amendments.

In favor: (3) Macmillan, Tyler, Fox
Against: (4) Proto, Greenhouse, Stevenson, McLaughlin
Abstention: (1) Snedeker
Motion failed.

Mr. Stevenson moved Attachment B – Tompkins County Sanitary Code, Article VII, Drinking Water Systems – Well Permitting Program removed. Failed for lack of a second.

Discussion to be continued.

Executive Session:

At 1:50 P.M. Mr. Greenhouse moved to go into Executive Session for the purpose of Personnel, seconded by Dr. Macmillan, Carried.

At 2:20 P.M. Mr. Proto moved to go out of Executive Session, seconded by Dr. Macmillan, carried.

During Executive Session the following action was taken: Mr. Greenhouse moved to approve submission of the 2009 budget, seconded by Dr. Macmillan, and carried unanimously.

Adjournment:

Dr. Macmillan moved to adjourn the meeting at 2:20 P.M., seconded by Mr. Greenhouse, carried.