Board of Health

Meeting Minutes
September 08, 2009

12:00 Noon
Rice Conference Room

Present:	Dr. Francis Fox; Mr. Brooke Greenhouse; Dr. James Macmillan, President; Mr. Michael McLaughlin, Jr.; Ms. Janet Morgan; Dr. Jeffrey Snedeker; 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; Dr. William Klepack, Medical Director; Mr. Jonathan Wood, County Attorney; and Mrs. Patty Stamm, Administrative Assistant
Guests:	Steven Kern, Sr. Public Health Sanitarian; Carol Chase, Sr. Public Health Sanitarian; David Park, Green Café; and Alex Degman, News Talk 870 - WHCU
Excused:	Mrs. Sylvia Allinger, Director of CSCN

 

Call to order

Dr. Macmillan, President, called the regular meeting of the Board of Health to order at 12:05 P.M.

Approval of Minutes:

Dr. Tyler pointed out that on Page 4 under “Approval to submit draft 2010 Budget,” he moved to approve the budget rather than Dr. Snedeker.   

Ms. Morgan moved to approve the minutes of the August 11, 2009 Board of Health meeting as amended, seconded by Dr. Snedeker, and carried unanimously.

Financial Summary:

Mrs. Grinnell Crosby passed out the Financial Summary for August 2009.  She pointed out the following items:

• Fifty percent of State Aid has been filed at the half point in the year, although no payments have been received as of yet.
• There are several sizeable checks that have not been posted yet by the County to the Preschool Special Education account.  She added they anticipate these to be posted sometime in the near future which will help balance this account. 
• Revenue lines, as well as spending, is being watched very carefully so as not to start 2010 with a deficit that would be extremely difficult for the Health Department to pay back.

Mrs. Cole also pointed out that included in this month’s BOH packet was an information sheet on Health Department Financial Trends which was requested at the August BOH meeting.

Administration Report:

Mrs. Cole discussed the H1N1 vaccine situation.  She stated currently they do not have a lot of information regarding it, adding they have more questions than answers.  Vaccine will be arriving at some point in time; however they do not know when it will arrive or how much they will receive.  It now appears that children will likely need two doses of vaccine; however older adults may only need one dose of the H1N1 vaccine.  Mrs. Cole stated they are trying to stay on top of everything, but added that it’s quite overwhelming with e-mails from the State, conference calls, etc.  She reported the State has assured her all the resources needed to conduct these clinics will be available, however added that the $70,000 they are providing will not be enough. 

Mrs. Cole stated currently it appears that soon the State will be sending out letters to local medical providers (i.e. private providers, CMC, TCHD) asking if they would like the vaccine.  She added there would be conditions of participation if the vaccine is accepted.

Dr. Snedeker voiced his frustrations regarding VFC (Vaccines for Children) and the inability to obtain the seasonal flu vaccine for children, stating it presents an ethical situation for practitioners such as himself since physicians are advised to give out vaccines for their insured patients, while at the same time they are being told they have to wait for the State vaccine for their Medicaid and uninsured patients.  Alice will share this concern with the staff.

Mrs. Connors reported they have already started vaccinating at the over 25 congregate sites in the County, as well as vaccinating homebound people in the community who are not currently on the Home Care caseload.

Medical Director’s Report:

Dr. Klepack reported that, in addition to signing policies, rabies orders, orders for therapy, etc., last week he was involved in a conference call with Cornell – Gannett Health Clinic, Ithaca College – Hammond Health Center, and Cayuga Medical Center trying to keep pandemic flu (H1N1) coordination and communication going.  He added this morning an e-mail came through reporting 290 cases of influenza at Cornell.  He added so far there have been no red flags in terms of morbidity/mortality.  Dr. Klepack discussed the challenges of coordination and communication of care plans for the student population.   “It is desirable that the advice given to students in the urgent care centers and the emergency room be consistent with that given by the college and university health care centers.  One of the outcomes of the pandemic flu planning being done by institutions of higher education, CMC, and TCHD has been to share patient education materials to accomplish this consistency.”

Regarding appropriate antiviral drug (H1N1) usage, Dr. Klepack stated the guidelines for drug usage were reviewed based on State guidelines.  Cayuga Medical Center released those in a communication to all of the Medical Center’s associated practitioners to help get everybody in the community prescribing drug therapy for influenza consistent with CDC guidelines.  Mrs. Cole added that at 11:30 this morning, the CDC issued new antiviral guidelines.  Dr. Klepack added part of the problem is how to inform the public as to who should not show up at an urgent care center/emergency room since if anybody shows up at the hospital they have to be evaluated.  He stated that private practitioners have the same challenge in terms of managing office practices.  Dr. Klepack stated currently the State plans to stick by plans to require private practices to report every single dose of H1N1 given on their registry.  He added he is hopeful that the State changes this regulation since he feels there might not be as high a participation in the private sector as would be desired if they stick to it.

Dr. Klepack emphasized that at this time the predominant flu strain circulation is the pandemic flu strain.  “Later in the season when seasonal flu appears, it will not be possible to be certain which strain of influenza the patient has since clinically they look the same.  Testing is not recommended since it does not affect treatment.  All influenza-like illness is to be treated as if we are certain that it is pandemic influenza.” 

Division for Community Health:

Mrs. Connors stated a flyer was included in BOH packets regarding the seasonal influenza vaccine clinics.  She added there will be 10 public clinics starting on September 23rd and running through October 7th.  She stated their goal is to complete the clinics for the seasonal flu vaccine before the H1N1 vaccine arrives.  She added there is a lot of confusion between seasonal influenza and swine flu.  She stated they are trying to use the term “seasonal flu,” but there is a difference between the vaccine and the illness – the illness without testing is being called “influenza-like illness” or “ILI.”  Mrs. Connors stated they would hopefully have more information regarding the H1N1 vaccination by the time public seasonal flu clinics start.

Children with Special Care Needs:

No report.

County Attorney’s Report:

Mr. Wood stated that he had nothing to report.

Environmental Health Report:

Mrs. Cameron:

• Stated there would be a representative from Green Café at today’s meeting.
• Announced they had received a phone call today regarding the section of Conger’s Mobile Home Park where there were sewage issues – this area is now vacant, the water has been shut off, and this should be the end of a difficult situation.
• Reported an inquiry had been received from the Environmental Management Council (EMC).  They have an interest in banning “BPA” which is a chemical used on the inside of plastic bottles such as baby bottles.  The EMC has passed a resolution to ban “BPA” in the County.

Approval of Revised Procedure:

Rabies Post-Exposure Vaccination: Authorization, Billing & Documentation Procedure:

Following withdrawal of this policy from the August BOH agenda for an additional revision due to a change in vaccination protocol, Mrs. Connors again presented it to Board members for their approval.

Mrs. Connors stated last week the Environmental Health staff requested an additional edit to the policy under I. Role Definitions: Section A., #l-B) so that it would read “authorizing rabies post-exposure treatment per TCHD Rabies Treatment Guidelines/Standing Orders and/or per medical order of TCHD Medical Director or New York State Rabies Treatment Algorithm (rabies treatment algorithm was passed around for Board members to examine).”  Mrs. Cameron explained the algorithm was something her staff has been using and they are trying to promote the use of this by medical providers. 

Dr. Snedeker moved to accept the procedure as revised and with the suggested edit, seconded by Mr. Stevenson.

Following further discussion regarding the wording of the suggested edit, as well as additional recommended edits to this procedure, the policy was withdrawn for additional review by Dr. Klepack and Environmental Health staff and will be brought back to Board members again next month for their approval.

Approval of Revised Immune Globulin Policy:

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

Violation of Part 14-1 of the NYS Sanitary Code:

Charles B. Park, Owner/Operator, Green Café, C-Ithaca;

David Park, representing Green Café, came to speak to Board members.

Mr. Park stated he had no prepared statement, but wanted Board members to know that following the most recent inspection Green Café changed the food holding containers from glass to mental to help maintain temperatures; he also added that temperature logs are now being used.  Mr. Park also stated employees are making an effort to follow the instructions given to them by the Public Health Sanitarian at the time of the inspection. 

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

Trung D. Lam, Owner/Operator, Wok Village, T-Ulysses;

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

Carol VanDerzee, Owner/Operator, Falls Restaurant, V-Trumansburg;

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

July 2009 Communicable Disease Reports:

Mrs. Connors distributed the most recent (July) DC 103 Summary of Disease Reports and Summary of DC103s by Disease without Name report for Board members to review. 

Dr. Klepack discussed the high numbers of reports of Lyme disease this summer, the prevalence of deer ticks in Tompkins County, daily tick check of clothing and skin following outside activity or for those with a high-risk occupation, as well as removal of ticks.  Dr. Klepack added that if a tick is removed within 24 hours, the risk of Lyme disease transmission is reduced   A short discussion ensued on the topic of ticks and Lyme disease.  

Adjournment:

Dr. Tyler moved to adjourn the meeting at 1:05 P.M., seconded by Dr. Snedeker; carried unanimously.