Board of Health

Meeting Minutes
August 12, 2008

12:00 Noon
Rice Conference Room

Present:	Dr. Francis Fox; Dr. James Macmillan; Mr. Michael McLaughlin, Jr.; Mr. Frank Proto; 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. Jonathan Wood, County Attorney; and Mrs. Patty Stamm, Administrative Assistant
Excused:	Mr. Brooke Greenhouse; Dr. Jeffrey Snedeker, President; Brenda Grinnell Crosby, Public Health Administrator; and Dr. William Klepack, Medical Director
Absent:	Mrs. Sylvia Allinger, Director of CSCN
Guests:	Steven Kern, Sr. Public Health Sanitarian

 

Since Dr. Snedeker was excused from this month’s meeting, Mr. Proto called the regular meeting of the Board of Health to order at 12:07 PM.

Approval of Minutes:

Dr. Tyler moved to accept the minutes of the July 08, 2008 meeting as written, seconded by Dr. Macmillan, and carried by a unanimous voice vote.

Financial Summary:

Mrs. Cole stated there was no Financial Summary for this month.

Administration Report:

• Mrs. Cole passed around an editorial written by Dr. Richard Orzeck of the Trumansburg Veterinary Clinic and a former student of the “most-esteemed Dr. Francis H. Fox,” who is quoted in this article. In Dr. Orzeck’s article, he discusses the topic of rabies, as well as stressing the importance of the need to keep current on your pets’ rabies vaccinations.
• Mrs. Cole invited Board members to stay after the meeting for a minute or two and take a look at the floor plan design for 55 Brown Road which was on display. She added they were still waiting for the State to officially acknowledge receipt of the Certificate of Need which was sent to them in July.
• Mrs. Cole gave a brief update on the Strategic National Stockpile drill in June which the Health Department participated in. Participation in this drill was mandated by the State. Mrs. Cole stated it was a good learning experience for staff, adding they will now rewrite their plan since they know what things need to be done differently.
• Mrs. Cole announced that Board members needed to be thinking about a President for the Board of Health for 2009. In 2008 Dr. Snedeker accepted the position for the year, but made it very clear it would be his last year as President. Mr. Proto added that the appointment of an Executive Committee of three people would also be necessary.

Medical Director’s Report:

Since Dr. Klepack was excused from today’s Board of Health meeting, there was no addition to his written report.

Mr. Proto stated Dr. Klepack had an interesting article in Monday’s (August 11th) Ithaca Journal regarding universal health care if anyone was interested in reading it.

Division for Community Health:

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

Children with Special Care Needs:

Mrs. Cole stated she was unaware that Mrs. Allinger would not be at today’s meeting, however would be glad to accept any questions relating to her written report.

County Attorney’s Report:

Mr. Wood responded to Mr. Greenhouse’s question from the July BOH meeting regarding what might need to be done in order to have the State authorize the Health Department to charge water fees in a reasonable manner, at the discretion of the Board of Health.

Mr. Wood stated initially he thought he could draft legislation regarding this, but then realized that it could not easily be done. Mr. Wood reviewed the laws, pointing out how convoluted they were and how hard it would be to draft a sensible law. Of note:

• The State Public Health Law, Section 1100, authorizes the State Health Department to regulate water; it doesn’t say anything about counties or local health departments.
• This law also authorizes the State Health Department to adopt rules and regulations governing water. The State Health Department has done this in Part V of the code. The code list basically defines the State Health Commissioner to include the local health commissioner, thereby giving the local health department the power to enforce the State health regulations. Regulations are not adopted by the State Legislature, but by the State Health Department. The State Health Department has included the county health departments as a group that enforces the State health regulations. Neither one says anything about fees or money.
• There are two places in the law where the fees and money come from, both of which are a little obscure. One is Section 606 of the Public Health Law, in the State Aid section. This section says counties can put together their fees for the year and submit them in their bi-annual report which the State approves. Mr. Wood added this was argued in court that, given this law says these fees can be charged and submitted to the State, which was done, and when the State approved them, they were OK. Neither court adopted this; their basic opinion being if the fee is no good, the State can’t approve it. Mr. Wood stated this was the law he was thinking of changing, however it has problems in that: 1) it’s very general …it doesn’t address any fee in particular, it just says all fees, and 2) it’s then subject to the approval of the State Health Department, which is very general. Mr. Wood stated fees are indirectly addressed in Section 347 of the Public Health Law. This is the section which gives the county Board of Health its powers, including adopting laws, rules, regulations, and the Sanitary Code. However, it doesn’t include the power to adopt fees. The NY Court of Appeals has held that this is the section which gives counties the right to charge fees. The court has said, although it’s not explicit, it’s implied.
• Basically, there are four relevant sections – the two which deal with water do not address fees at all; one section in the State Aid portion which addresses fees only in a very general way and subject to approval with the State; and then the power to really charge fees comes from a provision that doesn’t say anything at all about fees.

Mr. Wood again reiterated it would be difficult to get authorization to charge fees in the manner we want since the law is so convoluted. He stated what’s really giving us the power to charge fees is not anything that says we can charge fees, but other provisions which really don’t say anything about it. He added all of the rules are very general and too scattered to draft anything coherent without going back and revising the whole system.

Mr. Wood also stated that municipalities, including health departments, can charge a fee for services directly related to the service they are providing. However, if what you are charging the customer isn’t directly related to a service, then it’s a tax. Thus, if a client was provided with $50 worth of services and they were charged $150, $100 is an illegal tax. Mr. Wood stated this was the argument with people challenging fees; because it’s not directly related to a service they are receiving, it’s just a tax. He added the Tompkins County Health Department does not have the power to tax other than the property tax method.

Mr. Proto expressed his disagreement with Mr. Wood, stating if the State hasn’t prescribed a method by which a fee can be charged, it implies that an entity might charge a fee by whatever method they choose. Mr. Wood stated there is a very clear law that the fee has to be related to the service provided. Mr. Wood added the problem with this kind of a fee is the Health Department goes out and inspects water systems, but much of the money being charged is administrative fees which can’t really be tied to any service given to that particular system or individual. Because it can’t be related to the one who is being charged, it’s really a tax. Mr. Proto again stated he feels there is a way for the Health Department to set their own water fees, i.e. per capita as suggested by Mr. Greenhouse, and suggested seeking clarification from the Attorney General’s office.

A lively conversation ensued where Board members expressed their feelings regarding this issue. Mrs. Cameron stated Tompkins County seems to be the only county struggling with this issue since we are the only county which has been sued. She added there is one other county that also has high fees and these are charged per-capita, however no one has challenged these, so they are continuing to use the same fee structure. She stated most of the other counties in the State have lower fees than Tompkins, so it hasn’t been an issue for them. Mrs. Cameron stated for the 2009 budget, she looked at the actual time spent on providing technical service (not administrative cost) to the surface water systems and used that for their fees for 2009. She stated about a week’s worth of staff time was spent on each of those systems, as opposed to ½ a day to a day over a year’s period of time for ground water systems.

Mrs. Cole raised the issue of how much staff time, as well as Mr. Wood’s time, should be spent into continuing to look into this issue. Mrs. Cole stated the biggest issue was for the 2007 and 2008 budget to be kept whole since the revenue from those projected fees had already been put into the budget, which they ended up not receiving. She added Mrs. Cameron has put a reasonable fee into the 2009 budget and it balances, so she was unsure this issue was worth pursuing. Mrs. Cole also stated this issue could be revisited again next year when they start to think about the 2010 budget.

For the benefit of Mr. McLaughlin, the newest member of the Board, Mr. Wood briefly reviewed the history of the Bolton Point Water System suit against the Health Department. Following further conversation amongst staff and Board members regarding water systems and fees, Mr. Proto recommended this issue be brought forward again after the first of the year. Mrs. Cole suggested it be put off until spring when they start working on the 2010 budget.

Environmental Health Report:

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

 
Other Business

Approval for revision to the Childhood Lead Poisoning Prevention Policy:

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

Approval of new Vaccine Policy: Pentacel (DTaP-IPV/HIB):

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

Philip Conger, Owner, Conger’s Mobile Home Park – Tompkins County and New York State Sanitary Code Violations (discharge of sewage):

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

Christina Hatfield, 60 Moore Rd., T-Lansing – Request for Waiver of Tompkins County Sanitary Code S-6.06h.1 (sewage system):

Mr. McLaughlin moved to approve the Waiver Request, seconded by Dr. Macmillan, and carried by a unanimous voice vote.

Status of 2009 Proposed County Budget:

Mr. Proto briefly reported on the Legislature’s Budget Retreat of Tuesday, August 5th. He stated preliminary “soft numbers” show about a 1.6 million dollar shortage. If the Legislature approved all requests, there would be an approximate 5% tax increase. He added their goal is around a 3% tax increase.

New County Administrator:

Mr. Proto announced that Mr. Joe Mareane was selected and has accepted the position as the new County Administrator. Mr. Mareane is currently the Chief Fiscal Officer in Onondaga County.

 

Adjournment:

Dr. Macmillan moved to adjourn the meeting at 1:08 P.M., seconded by Dr. Tyler, carried.