Board of Health

Meeting Minutes
June 09, 2009

12:00 Noon
Rice Conference Room

Present:	Dr. Francis Fox; Mr. Brooke Greenhouse; Dr. James Macmillan, President; Michael McLaughlin, Jr.; Ms. Janet Morgan; Dr. Jeffrey Snedeker; Mr. Greg Stevenson; 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; and Mrs. Patty Stamm, Administrative Assistant
Excused:	Mr. Jonathan Wood, County Attorney
Guests:	Steven Kern, Sr. Public Health Sanitarian; Carol Chase, Sr. Public Health Sanitarian; Pam Mackesey, Tompkins County Legislature; Kevin Jacobs, Owner, Collegeview North Mobile Home Park; Hope Rich, Owner, Hope’s Way Café and Catering with guest; Frank Rogan, Manager, Sunset Grill; and Frank Proto, Tompkins County Legislature

 

Dr. Macmillan, President, called the regular meeting of the Board of Health to order at 12:03 P.M.

Approval of Minutes:

Dr. Tyler moved to approve the minutes of the May 12, 2009 Board of Health meeting as written, seconded by Mr. McLaughlin, and carried unanimously.

Financial Summary:

Mrs. Grinnell Crosby distributed the May 2009 Financial Summary, stating there was nothing major to report at this time.  She stated the Community Health revenue is at 51% at the end of May.  This is due in part to some significant Home Care revenue from last year being cleaned up.  Mrs. Grinnell Crosby also added they are at about 23% of the public health work state aid, which is fairly close to where it should be at the end of the first quarter.   

Administration Report:

Mrs. Cole:

• Passed around a “Thank You” letter she had received from the two co-directors of the Syracuse Regional Office of the NYSDOH thanking the Health Department staff for their efforts in making Dr. Daines’ visit during Public Health Week such a success. 
• Stated currently there are three confirmed cases of Swine Flu (H1N1) in Tompkins County.  She added they are no longer testing individual cases unless the individual is hospitalized and in serious condition; now they are just looking for clusters or groups of illness.
• Reported there may be some sort of flu vaccine for H1N1 forthcoming in the fall which will be given in two doses.  This means that in addition to the regular seasonal flu clinics, they will have to do separate clinics for the two doses of H1N1 flu vaccine, which will triple the amount of fall clinics.  She added this will be a challenge since the Health Department is scheduled to pack up and move to Brown Road on November 1st, along with keeping up with the regular day-to-day duties.  Mrs. Cole stated the good news is that the vaccine will be supplied by the Federal government and extra money will be available for additional staffing, as well as supplies. 
• Mrs. Cole elaborated a little on the dissatisfaction of the Syracuse Regional Office WIC staff regarding the design of the space for the WIC staff at Brown Road.  She stated that the walls are up and it’s past the design stage.  Unfortunately, it’s too late for input at this time; this should have been done a year and a half ago.  Mrs. Cole also stated the Health Department sponsors the WIC Program; WIC is a tenant in our building.  She added if the NYSDOH WIC Program wants to make changes to the design of the WIC space in the new building, then they will have to fund it.  Mrs. Connors added they have just heard that the Syracuse Regional Office, who approves their site application prior to the State review, has decided Nutrition staff can meet with their clients in their cubicles, which are not designed to accommodate clients, rather than pay the rental costs for the use of the clinic rooms.  Mrs. Cole further added the Certificate of Need was submitted to the Albany office last July.  Apparently the Syracuse Regional office and the Albany office are not communicating otherwise the Syracuse Office would have been aware of the design a year ago. 
• Dr. Snedeker offered congratulations to Health Department staff that were recognized at the Employee Recognition Breakfast on May 28th for their years of service to the Health Department.

Medical Director’s Report:

Dr. Klepack stated he had nothing to add to his written report.

Dr. Macmillan asked Dr. Klepack to show his power point presentation on “Pandemic Flu Planning for Private Offices” at a future Board of Health meeting, perhaps in August. 

Division for Community Health:

Mrs. Connors reported:

• As of Monday, June 8th, there are officially 1,007 confirmed cases of Swine Flu cases in New York State.  She passed around a handout of the State showing a breakdown of numbers within the counties. 
• A press release was sent out regarding the last two suspect cases of Swine Flu.  On Saturday, June 6th, TC3 put out a press release regarding the third suspect case, which was identified as a TC3 student.  Mrs. Connors added Tompkins County Health Department does not announce gender or age, only whether it is a child or an adult, nor do they announce the locality to protect the confidentiality of those involved.
• The Health Department received official notice today that Family & Children’s Services are closing their Home Health Aid services to the Health Department as of June 30th.  Mrs. Connors added they had previously received verbal notification of this closure and have already started the planning process.  She added, at this point, they believe they will be able to serve all of the clients currently being served by Family & Children’s Service. 

Children with Special Care Needs:

Mrs. Allinger reported contracts for all of their agencies and individual providers in Early Intervention and Preschool will be going out by the end of the week.  This includes about 45 individuals and 12 different agencies.  She added the Transportation RFP was posted on Friday, June 5th, so they will be going through that process for the next couple of weeks. 

County Attorney’s Report:

There was no report since Mr. Wood was excused from today’s meeting.

Environmental Health Report:

Mrs. Cameron reported:

• She was anticipating three individuals with items on today’s agenda to attend the meeting: Hope Rich from Hope’s Way; Kevin Jacobs from Collegeview North MHP; and Frank Rogan from Sunset Grill.
• Her Division has been receiving some inquiries from Ernie Bury regarding potential development of low income housing on less than quarter acre lots with public water.  She added they haven’t received anything official at this point.  They did tell Mr. Bury they anticipated they would deny any applications for quarter acre lots.  Mr. Bury has contacted some of the local Legislators regarding this issue.   Mrs. Cameron added the Environmental Health Division has responded to these people stating their position. 

 
Approvals and Actions
 

Request from Pamela Mackesey, County Legislator, to address the Board: 

Ms. Mackesey, County Legislator representing the South Hill district, addressed the Board regarding her frustrations over a public health problem stemming from the effects of pollution from industries uphill from the South Hill residents.  She added this has been going on for years, and although the DEC has been involved at various points and Emerson/Borg Warner have also responded, she is still concerned since 2,200 micrograms per cubic meter have recently been found in soil vapors (acceptable levels are less than 100 mcg/cubic meter) along the sewer line in the South Hill area.  Ms. Mackesey added there is a school in this area, as well as several families with children.  She stated it feels as though no one is paying any attention to this problem and again expressed her concern over the danger the people of South Hill are being subjected to.  She further stated that she has come before the Board since she doesn’t know what else to do.  She knows the DEC is working on this issue, but feels that more voices are needed at the local level to urge them on.  Ms. Mackesey stated she was hopeful this issue could be added to a future Board of Health meeting as an agenda item for discussion.

Mrs. Cameron explained that she met with Ms. Mackesey a year and a half ago regarding this concern and she contacted the State Department of Health at that time.  She added that at this point her Division has not been actively involved.

Dr. Tyler moved that Mrs. Cameron or a staff member from the Environmental Health Division organize an informational session on this topic for a future Board of Health meeting, perhaps in August.  Dr. Macmillan requested some written materials regarding this issue be available at July’s meeting and then perhaps schedule the informational session for the August Board of Health meeting.  Mr. Greenhouse seconded the above motion.

Further conversation concerned the city’s involvement in this issue.  Ms. Mackesey reported recently Mayor Peterson wrote a letter to the DEC expressing her concern about what has been happening.  At Dr. Macmillan’s request, Ms. Mackesey stated she would see that the Board received a copy of this letter.

Motion carried unanimously.

Hope Rich, Owner, Hope’s Way Café and Catering T-Ithaca; Violation of Part 14-1 of the NYS Sanitary Code (Food Service): 

Hope Rich from Hope’s Way thanked Board members for the opportunity to speak.  She discussed the issue at hand which involved a soy milk product.  She stated that all violations have been corrected; a temperature log has been created for the milk which is stored in thermal carafes, as well as regularly changing ice balls.  Ms. Rich stated her establishment has a good reputation, long-term employees, and always strive to correct any items Health Department staff brings to their attention.  She asked the Board for their consideration in reducing the fine.

Mr. Greenhouse moved that the resolution be accepted with a reduction in the penalty to $200, seconded by Dr. Snedeker.  Resolution as amended carried unanimously.

Kevin Jacobs, Owner, Collegeview North Mobile Home Park, T-Enfield; Request to Appeal Penalty:

Mr. Jacobs came before the Board to discuss the penalty that was adopted on April 14th for operating without a permit.

Mrs. Cameron updated Board members on the current status of Collegeview North Mobile Home Park stating that Mr. Jacobs is in compliance with the April 14th BOH resolution with one minor issue of a site plan that needs to be submitted.  She added Mr. Jacobs is currently working with the engineer on an updated site plan.

Mr. Jacobs explained he was working with an engineer who was handling all permits and thought he was in compliance to proceed with developing and operating three new lots designed by the engineer.  He was not aware that he was out of compliance until this year when he went to renew his permit.  He stated he and his father have been operating two mobile home parks, one since 1983, as well as doing work in Tompkins County for many years and would never have knowingly broken the law.

Mrs. Cameron clarified that they are receiving different accounts from all individuals involved in this issue.  The point still remains that the construction of a sewage system and expansion of the mobile home park was done without Health Department approval and construction permits.  She added they didn’t issue an approval in the end since the system was already installed.  Mrs. Cameron stated they did get the plans from the engineer and a notice of non-compliance was issued stating it was OK to use the system.  Mrs. Cameron also reported Mr. Jacobs previously had a violation for water system modifications without the approval of her Division.  She added this prior history is one of the reasons why the penalty was set at $2,000.  She did add Mr. Jacobs has been very cooperative and reiterated that she and her staff are pleased with the efforts Mr. Jacobs has been making and would not be opposed to a reduction of the penalty.

Mr. Jacobs stated the new water system was up and operating in September, 2005.  He stated that he had a water system which was breaking down; a new well was dug and the whole park was redone.  He stated they did not have time to wait for approval to hook up the water the tenants needed.  He added the well was tested and the results were submitted to the Health Department before it was hooked up.  He stated he had documentation of this, although he did not have it with him.

Mr. Stevenson stated he was pleased to hear that the Environmental Health Division was agreeable to reducing the fine for Mr. Jacobs.  He asked both Mrs. Cameron and Mr. Jacobs what they felt a reasonable fine might be.  Mr. Jacobs again stated he had no excuse, adding he did not knowingly or willingly construct the septic system and hook it up with the knowledge he was in violation of the law.  He again reiterated that his Engineer told him to go ahead and take the steps necessary to get the job done, which is what he did.  Mrs. Cameron stated she would support a decrease in penalty, although expressed concern that Mr. Jacobs is the owner/operator of the mobile home park and he needs to know what he is required to do before taking these actions.  She also reported Mr. Jacobs was given the opportunity to come to the meeting last month to present his case, however they received no notice from him that he would attend the meeting.  She stated her Division would support a fairly modest reduction in the penalty.  Mrs. Cameron answered questions from Board members regarding penalties for violations, as well as communication during this process.

Mr. Stevenson made a motion that the fine in this action be reduced from $2,000 to $500.  There were no seconds.

Dr. Tyler proposed the fine be reduced to $1,500, seconded by Mrs. Morgan. Mr. Greenhouse asked if the letter of complaint the Environmental Health Division sent to the NYS Department of Education regarding the Engineer involved in this issue could be shared with Mr. Jacobs if he requested it.  Mrs. Cameron stated she would check with Mr. Wood, County Attorney, regarding this, but felt that it was public knowledge.

Mr. Jacobs expressed the feeling that the fine was excessive, citing lower penalties assessed to other mobile home parks.

Mr. Stevenson stated he would not vote in support of this latest motion, adding he felt the fine was still too high, based on his experience in the Town of Enfield, as well as within Collegeview North MHP.

Dr. Tyler stated he was willing to reduce his proposed motion to $1,000, which was agreeable to Mrs. Morgan.  Motion passed with one opposing vote by Mr. Stevenson. 

Matthew Torchia, Owner/Operator, and Frank Rogan, Manager, Sunset Grill, T-Ithaca; Violation of Part 14-1 of the NYS Sanitary Code (Food Service): 

Mr. Rogan, Manager of the Sunset Grill, spoke before the Board.  He stated he has been in the restaurant business for 28 years and has had several restaurants under his jurisdiction prior to the Sunset Grill; he has only had one other critical violation back in 1996.  He added he is working with a whole new crew.  They are now keeping temperature logs, which he had with him.  Mr. Rogan stated for the first year and a half that the Sunset Grill was in business, eggs were kept on the counter; they were never told the eggs couldn’t be there.  They have now been advised and the eggs have been moved to the deli, which is called the “egg deli.”  He added since this is a new business and in view of economic times, he feels the fine is rather harsh.  Mr. Rogan reported there is more restaurant competition in Ithaca than in any other city per capita.  He added his staff made a mistake and felt they had suffered penalty enough from the shame of being written up in the paper.  He advised this would not happen again and thanked the Board for their time.

Mr. Greenhouse moved the resolution be accepted with a reduction in the penalty to $200, seconded by Mr. Stevenson, and carried by a unanimous voice vote.

Sandra Brocious, Beech Hill Pond Community, T-Danby; Request for Waiver of Tompkins County Sanitary Code S-6.06 b.1:

Mrs. Cameron reported that Beech Hill Community does not have electricity.  She added the Code Enforcement Officer and the Health Department are working to bring them up to code in several areas.  The Health Department issued a resolution that essentially any units that were unoccupied had to come into compliance before they were occupied.  Mrs. Cameron stated this is the same sewage system that was put in for two occupied units, however since this unit was a new system and not a replacement, it requires a waiver.  She added that this facility has such little use, primarily since it is just seasonal occupancy, and their flow rates are so low that her Division does not expect to have any issues with it.  Mrs. Cameron stated they do plan to go out and inspect the sewage systems since they are alternative systems to see how they are operating.  It was noted that this is a grey water sewage system and that they have a separate communal toilet facility.

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

Philip and Barbara Conger, Owners, Conger’s Mobile Home Park, T-Dryden; Violations of Part 17 of the NYS Sanitary Code and Article VI of the Tompkins County Sanitary Code (Sewage):

Mrs. Cameron reviewed the recent history of  events at Conger’s MHP.  Quite a while ago Conger’s MHP was found to be constructing a sewer system without the Health Department’s knowledge.  They were fined at that point.  Conger’s MHP got an Engineer and contractor to replace the sewage system.  The Health Department had concerns with the engineering, as well as construction.  The system was installed and failed within a month.  Repairs were done to the system.  When the Health Department visited in April, the system had again failed.  Barbara Conger stated she no longer had the funds to do any work with the sewage system.  In the meantime, she is trying to take action against the contractor and Engineer and visa versa.  Since Mrs. Conger had to do something to address the sewage system, she said she would close Park #2.  Upon making this decision, Mrs. Conger gave the tenants 30 days notice.  The tenants have since been in touch with NYS Division of Housing.  The Health Department has been working with Mrs. Conger on this issue.  Mrs. Conger has now given the tenants proper notice, giving them six months to move out.  There are now only 10 occupied units out of 28, so this should be decreasing flows to the system and the Congers have agreed to daily monitoring.  Mrs. Cameron stated her Division is pleased with the action the Congers are taking given the difficult situation.

Mr. Kern made reference to a comment Mr. Jacobs had made earlier in the meeting that other mobile home parks were being assessed lower fines.  Mr. Kern stated the Congers have had penalties assessed in excess of $500 and he also pointed out that the Congers are closing one of the sections in their mobile home park.  He stated those penalties along with the closing of Park #2 does make for a fair balance of what is right.

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

Keith Hoffman, Manager, Newfield Estates Mobile Home Park, T-Newfield; Review of Deferred Penalty:

Mrs. Cameron stated Mr. Hoffman has been cooperative.  She added that all required reports have been submitted since the previous resolution was adopted, as well as all well caps being properly sealed as required.

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

Approval of Revised Policy/Procedure: Revised Clinic Infection Control Policy & Procedure:

Mrs. Connors reviewed revisions to the policy/procedure.  Of particular note, on the Immunization Questionnaire, a lot more detail has been added to the insurance information.  Also, under the name and after gender information, they ask if the patient is Native American.  Mrs. Connors explained that under the Federal Vaccine Program for Children, anyone who is a Native American is automatically eligible for free vaccine, regardless of their insurance status or ability to pay.  She added for people who have no insurance or meet the income eligibility guidelines, they would also be eligible to receive immunizations for free.

Following several recommendations from Board members, the Clinic Infection Control Policy & Procedure was approved with the following edits:

• Section III, A, #3 – Delete ‘spray alcohol foam’ and substitute ‘alcohol based disinfectant’.
• Section III, A, #3 (a) – Delete sentence and substitute the following: “If alcohol based disinfectant product is used follow manufacturer’s instructions.”
• Section III, A, #3, (d) – Substitute ‘are required’ for ‘should’.
• Section III, B, #5, – Substitute ‘will’ for ‘should’.
• Revise the Roman numeral headings, Clinic Staff is Section IV (not III), etc.
• Section IV (Clinic Staff), B – Delete ‘Ill clinic staff should not work’ and in last sentence, delete ‘in this situation’ and substitute ‘as appropriate’.  (The responsibility falls to the supervisor to assess whether staff is too ill to work should they report to work even when ill).
• Section IV – Reference CHS policy that defines what ‘ill’ means, i.e. fever, etc.
• Section V (Clinic Clients) – Revise font in this section to be consistent with rest of document.
• If ‘social security number’ is not needed on the Immunization Questionnaire for billing and/or identification purposes, then delete.

            Dr. Snedeker moved to approve the revised policy & procedure as modified, seconded by Mrs. Morgan, and carried by a unanimous voice vote.

Approval of Revised Policy: Revised Rabies Pre-Exposure Vaccination Policy:

Mrs. Connors reviewed revisions to the policy.

Following recommendations from Board members, the Revised Rabies Pre-Exposure Vaccination Policy was approved with the following edits:

• Section G – Move #1 and #2 into section F (Contraindications).
• In Section G, add additional statement, “Vaccine will not be given to persons with known hypersensitivity.  Advise client to consult with their medical provider.”
• In attached letter to client, add job titles for Karen Bishop and Carol Mohler.  Will need to be updated if there are any name changes.

Dr. Snedeker moved to approve the revised policy as modified, seconded by Mrs. Morgan, and carried by a unanimous voice vote.

Request from Frank Proto, County Legislator: 

Mr. Proto came before the Board regarding the letter he signed on behalf of the Water Resources Council regarding natural gas drilling wastewater disposal.  In regards to the resolution the Board passed on hydrofracking, he asked if the Board would consider passing another resolution asking for an extension of time from 30 to 60 days to review proposed regulations.  Mrs. Cameron stated that she would put a letter together for the Board’s approval.      

For Discussion: Division of Environmental Health Fees Proposed for 2010:

Mrs. Cameron distributed a revised fee schedule, pointing out minor modifications that had been made.  Mrs. Cameron reviewed the fee schedule and answered questions Board members had regarding fees.

Following a brief discussion, Mr. Greenhouse moved to adopt the revised proposed Environmental Health Fee Schedule for 2010, seconded by Dr. Snedeker, and carried by a unanimous voice vote.

Mrs. Cole reminded everyone the Environmental Health fee packet is part of the total Health Department budget package which will be brought before the Board at the July meeting for their approval.

Adjournment:

Dr. Snedeker moved to adjourn the meeting at 1:55 P.M., seconded by Dr. Macmillan.  Carried.