Board of Health

Meeting Minutes
January 13, 2009

12:00 Noon
Rice Conference Room

Present:	Dr. Francis Fox; Dr. James Macmillan, President; Dr. Jeffrey Snedeker; and Dr. William Tyler
Staff:	Mrs. Sylvia Allinger, Director of CSCN; 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; Dr. William Klepack, Medical Director; Mr. Jonathan Wood, County Attorney; and Mrs. Patty Stamm, Administrative Assistant
Excused:	Mr. Greg Stevenson and Mr. Brooke Greenhouse
Absent:	Mr. Michael McLaughlin, Jr.
Guests:	Eileen O’Connor, Cayuga County Director of Environmental Health; Jessica Miles, Owasco Lake Watershed Inspector; Yeshi Tsondu, Cajun Café Grill, and Guest; Ricky Park, Cornell Pre-Med Student; Steven Kern, Sr. Public Health Sanitarian; and Carol Chase, Sr. Public Health Sanitarian

 

Dr. Macmillan, President, called the regular meeting of the Board of Health to order at 12:12 P.M.

Dr. Snedeker introduced Ricky Park, a Cornell Pre-Med student, who is spending the day “shadowing” Dr. Snedeker. 

Mrs. Cameron introduced Eileen O’Connor from the Cayuga County Health Department and Jessica Miles, Owasco Lake Watershed Inspector.

Approval of Minutes: 

Due to lack of a quorum, the minutes from the December 9, 2008 meeting could not be voted on for approval at this time.

Financial Summary:

Mrs. Grinnell Crosby reported there was no 2008 Financial Summary at this point.  She stated they were still working on closing the 2008 books. She added that a State Aid Claim needed to be filed by the end of February, which likely meant the 2008 Financial Summary would not be ready until March.  Mrs. Crosby stated on December 8, 2008 they were notified the 3rd Quarter State Aid had been paid. 
            Mrs. Crosby distributed a “2009-2010 Executive Budget” summarization of the impacts to the local Health Department based on the Executive Budget proposal.  She stated currently the Health Department is looking at a loss of about $275,000.  She also added there is a proposal to require Certified Home Health Agencies to hire HHA’s as employees rather than to contract with licensed home care agencies.  Mrs. Crosby stated, based on a study she and Mrs. Connors had done in 1999/2000, the cost was significantly higher for the Health Department to employ their own aids rather than contracting with local licensed home care agencies.  That figure is not included in the $275,000.  She estimates this could be an additional $700,000, which would bring the total funding reductions to public health at about a million dollars.  The other item which is unknown is the proposed shift to a prospective payment system which is too difficult to project on an agency to agency basis.  Mrs. Crosby stated they are looking paying similar to the way Medicare is currently paying for home care. 
            Mrs. Cole stated the big loss is all of the funding for the Bioterrorism Preparedness Program ($111,501), which includes two staff members.  Currently, they are trying to revamp their Bioterrorism Preparedness plan, as well as doing a Special Needs Plan and Strategic National Stockpile Plan.  She added all the pieces of the plan are labor intensive and trying to absorb this back into the Health Department would be a major hardship. 
            Mrs. Crosby stated, to further complicate matters, Medicare will be looking at going to a performance-based payment system.  Typically there has been a small increase each year in the rate being paid for Medicare; however this does not seem to be in the federal budget plan for this year.  This means the Health Department could be affected in the “CHHA” (Certified Home Health Agency) area from a number of different directions, depending on proposed budget cuts. 
            A lively conversation ensued regarding impacts to the Health Department based on the above information.    

Administration Report:

In addition to her written report, Mrs. Cole:

• Passed out packets of additional information received on the Marcellus Shale drilling. 
• Announced that following the passage of the Marcellus Shale Resolution at the December 2008 BOH meeting, she received a call from Senator Schumer’s office expressing their appreciation for receiving a copy of the resolution and stating they saw this as an important public health issue. 
• Passed around coffee “cozies” and coasters with the new STD logo “Get the Facts.”  In addition to developing the website (tc-std.info), these initiatives were purchased with money received for education and outreach from a STD Grant.  These items will distributed out into the community, predominately to the college students.

Medical Director’s Report: 

Dr. Klepack’s report was distributed at today’s meeting.  In view of this, Dr. Klepack briefly reviewed the background regarding the section on “Immunization – Public Health and the Private Sector” for the benefit of those present.  He stated the bottom line is a bit disconcerting due to the fact that 5% of pediatricians and 20% of family physicians are considering giving up providing vaccines due to the fact that the amount of reimbursement they received did not keep pace with the costs and risks involved.  If such a thing were to happen, this would put an additional burden on public health. 
            Mrs. Connors noted that when she first came to the Health Department about 15 years ago they were giving approximately 12,000 immunizations per year for children, primarily due to the fact that liability costs were so high for physicians.  Over time this has changed, payment structures have gone up, and last year the Health Department was down to about 1,000 immunizations for children.  She added if physicians reduce the number of vaccines they provide to children, the trend could reverse and the Health Department’s immunization numbers could start to increase again, which would be a significant impact. She stated the immunizations really need to be given in the physician’s health care practice.  She stated the role of the Health Department is to serve the under insured and difficult to reach populations.   

Division for Community Health:

Mrs. Connors was pleased to announce they have hired someone to fill the WIC Nutrition Educator position that has been vacant since July of 2008, Lester McNair, who will start February 9th. 

Children with Special Care Needs:

Mrs. Allinger reported:

• Effective January 1, 2009, physicians will be required by NYS Legislature to screen at 18 months and 24 months for developmental delays.  Mrs. Allinger will be meeting with Dr. DeSilva and Dr. Casey to discuss this requirement since both doctors feel this will significantly impact the number of referrals within the CSCN Program.  Mrs. Allinger added she would have more to report on this next month. 

County Attorney’s Report: 

Mr. Wood stated he had nothing to report.

Environmental Health Report: 

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

 
Approvals and Actions

Approval of Revised Policy/Procedure: Patient Fall Assessment and Documentation Policy/Procedure: 

Due to lack of a quorum, no action could be taken on this Policy/Procedure at today’s meeting.  Postponed until February 10th.

Yeshi Tsondu, Owner/Operator, Cajun Café Grill, V-Lansing; New York State Sanitary Code Part 14-1 Violation (Food Service Establishment): 

Although no action could be taken on this violation at today’s meeting, Mr. Yeshi Tsondu was present at the meeting; Mrs. Chase, Sr. Public Health Sanitarian, spoke on his behalf.
            Mrs. Chase stated Mr. Yeshi Tsondu is the Owner/Operator of the Cajun Café Grill.  She added he was a relatively new owner at the time of the violations.  The first inspection after the Permit was issued was a violation and then a subsequent inspection had the same issue.  Mrs. Chase stated Mr. Tsondu has attempted to resolve the situation by developing temperature logs (which he presented at today’s meeting) and added Mr. Tsondu is also putting smaller amounts of food in the buffet line so the heat is not going off the food as rapidly; it’s now contained and down closer to the heat source. 
            Dr. Macmillan stated the Board would take note of Mr. Tsondu’s reactions to resolving the violations and a final vote would be taken the time the Board reaches a quorum.  He thanked Mr. Tsondu for attending today’s meeting.  

Mr. Kenneth P. Fiero, Fraternal Order of Eagles #1253, C-Ithaca; Clean Indoor Air Act (CIAA) Waiver Renewal Request:

Due to lack of a quorum, no action could be taken on this Waiver Renewal Request at today’s meeting.  Postponed until February 10th.

Owasco Lake Watershed Regulations – Implementation in Tompkins County and Potential Board of Health Enforcement: 

Mrs. Cameron stated the Owasco Lake Watershed Regulations have been in effect for over 20 years; however, they have never been enforced in Tompkins County.  Currently, the City of Auburn and the Town of Owasco fund a Watershed Inspector, Jessica Miles, who would like to develop and implement an education and outreach plan in coordination with Tompkins County prior to initiating inspections in Tompkins County.
            Mrs. Cameron added the regulations cover a broader area than the NYS and Tompkins County Sanitary Code and some of the requirements are different than those in Tompkins County.  She stated staff members from Cayuga County and Tompkins County have worked over the past year to clarify parts of the regulations and their implementation in Tompkins County.  This proposal is being brought before the Board of Health since violations that are not cooperatively resolved would be referred through the Tompkins County Division of Environmental Health to the Board of Health for enforcement.
            Mr. Wood commented that these rules and regulations have been in effect for 25 years without anyone to enforce them, adding that since part of Tompkins County is in the Owasco Lake Watershed district it applies to Tompkins County.  However nobody has really been aware of this.  He added staff from Cayuga County and Tompkins County met a few months ago and put together a list of requirements of the regulations not addressed in the NYS and Tompkins County Sanitary Code which are currently enforced (included in BOH packet).  Mr. Wood stated one thing that became clear from the meeting and subsequent discussion was that there weren’t a lot of requirements that were different.  He further stated he didn’t feel there was any action for the Board of Health to take at this time other than to be aware of it.  Mr. Wood stated that while he agrees with the regulations and the fact that they seem to apply to Tompkins County, he feels that anyone accused of a violation would have a good argument that nothing has been done for 25 years.  Mr. Wood added the purpose is to protect the Watershed and by going forward with this, it would likely help to do that.  He stated he wasn’t against endorsing this, but just reminded everyone there could be an issue if an enforcement action ever came forward.  
            A short discussion followed between Board members, staff, Jessica Miles, and Eileen O’Connor.  Since this was an information only item, no additional action was required.  Mr. Wood stated it would be fine for the Board to give direction, however there is really nothing legal that needs to be voted on.  Board members did not voice any objection with Ms. Miles developing an education and outreach program and then proceeding to initiate inspections in Tompkins County.     

Decision on Proposed Revision to the Tompkins County Sanitary Code, Article VII – Water Supply (Held over from December):

Due to lack of a quorum, no action could be taken on this policy/procedure at today’s meeting.  Postponed until February 10th.

Proposed Mold Policy:

Mrs. Cameron stated her Division has no specific policy for mold complaints.  This proposed policy is a slight change in procedure since staff had been going out to investigate mold situations if people called with a lot of concerns or had a significant mold problem.  Since there are no Federal, State or local regulations or standards for mold in the home, and considering budget constraints, the Division will not routinely investigate mold complaints or service requests.  Educational information will be provided.  Individuals with concerns will be directed to the Code Enforcement Officer since most mold problems are related to water issues or they will be directed to their physician.  Mold complaints will be investigated by the Division at the request of a Code Enforcement Official or medical provider. 

55 Brown Road:

Mrs. Cole updated Board members on the status of 55 Brown Road.  She stated deconstruction has been completed ahead of schedule.  The goal was to recycle 85-90% of the materials, which was exceeded.  Bids have been opened for the four levels of contracting: heating, plumbing, electrical, etc.  As soon as approval is received from the Legislature, bids will be awarded and then the full interior renovation will be started.  Currently, everything is on schedule, with an anticipated move in October/November. 

Adjournment:

Meeting was adjourned at 1:00 P.M.